Abstract: SA-PO864
Automated Urinary Albumin Creatinine Testing in Stage 3 CKD and Effect on Prescriptions of ACE Inhibitors and ARBs
Session Information
- CKD: Socioeconomic Context and Mobile Apps
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Park, Ken J., Kaiser Permanente, Salem, Oregon, United States
- Thorp, Micah L., Northwest Permanente, Happy Valley, Oregon, United States
- Unitan, Robert, Noorthwest Permanente, Portland, Oregon, United States
Background
Kidney Disease Improving Global Outcomes recommends assessing for albuminuria annually in patients with chronic kidney disease (CKD). Despite this recommendation, many patients with CKD do not undergo annual testing for albuminuria. We were interested in whether automated testing in CKD for annual urinary albumin creatine (ACR) testing improved ACR testing and prescribing of ACE inhibitors and ARBs.
Methods
We defined a CKD 3 cohort registry in April 2018 in Kaiser Permanente Northwest. We compared ACR testing and filled ACE inhibitor and ARB prescriptions in the year before and after April 2018 after implementing a quality improvement project targeting patients with stage 3 CKD based on eGFR criteria or ICD-10 codes. A web-based tool examined the registry and ordered an ACR in those patients that did not have an ACR checked within the past year. In those patients not on an ACE inhibitor or ARB who had a renal indication, primary care providers received an alert in the electronic health record (EHR) which recommended initiation. Renal indications for an ACE inhibitor or ARB were hypertension and an ACR > 30 mg/g with diabetes mellitus (DM) or an ACR > 300 mg/g without DM.
Results
There were 11,229 patients in the initial CKD registry with index date of April 2018. Average age was 72.7 years, 37.4% had DM, 79.4% had hypertension, and mean eGFR was 46.8 ml/min. One year after implementation of annual ACR testing, the registry decreased to 10,934. Average age was 73 years, 37.1% had DM, 79.4% had hypertension, and mean eGFR was 47.4 ml/min.
One year after implementation of ACR testing, rate of ACR testing increased from 25.1% to 83% (p < 0.001). In patients with renal indication, ACE inhibitor or ARB use increased from 77.4% to 80.2% but was not significant (p = 0.07). Maximum dose ACE inhibitors or ARB use increased from 26.8% to 32.1% (p = 0.02) in patients with A3 grade albuminuria and hypertension.
Conclusion
In patients with stage 3 CKD, a population-based tool that automated testing of ACR linked with EHR alerts resulted in a significant increase in ACR testing but did not result in a significant increase in ACE inhibitor or ARB prescriptions in patients who had a renal indication. However, prescribing of maximum dose ACE inhibitors or ARBs did increase in patients with A3 grade albuminuria and hypertension.