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Kidney Week

Abstract: TH-PO459

Frequency of eGFR and Albuminuria Measurement in Patients with Diabetes and/or Hypertension in 27 Health Care Organizations

Session Information

Category: CKD (Non-Dialysis)

  • 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Stempniewicz, Nikita, AMGA (American Medical Group Association), Alexandria, Virginia, United States
  • Ciemins, Elizabeth, AMGA (American Medical Group Association), Alexandria, Virginia, United States
  • Sang, Yingying, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
  • Matsushita, Kunihiro, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
  • Ballew, Shoshana, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
  • Grams, Morgan, Johns Hopkins University , Baltimore, Maryland, United States
  • Chang, Alex R., Geisinger Medical Center, Danville, Pennsylvania, United States
  • Levey, Andrew S., Tufts Medical Center, Boston, Massachusetts, United States
  • Cuddeback, John K., AMGA (American Medical Group Association), Alexandria, Virginia, United States
  • Coresh, Josef, Welch Center for Prevention, Epidemiology & Clinical Research, Baltimore, Maryland, United States
Background

Clinical guidelines for diabetes recommend screening for chronic kidney disease annually with spot urinary albumin-to-creatinine ratio (uACR) and estimated glomerular filtration rate (eGFR). For hypertension, measures are recommended at diagnosis to establish a baseline for medication use, and to screen for secondary causes of hypertension, with eGFR listed as a basic test, and uACR optional.

Methods

Using a large, geographically diverse clinical dataset from 27 health care organizations (HCOs), 580,950 patients with diabetes and 1,558,525 patients with hypertension were identified, among a population aged 18-85, with ≥ 1 face-to-face ambulatory encounter with a primary care provider in 2018, and no prior evidence of end stage renal disease. Measurement rates were described in 1-year (2018), 2-year (2017-2018), and 3-year (2016-2018) periods, overall and for HCOs at the 5th and 95th percentile. Measurements were limited to quantitative values recorded in a structured field in the HCOs’ electronic health records.

Results

Overall, 89.1% of patients with diabetes and 85.1% with hypertension had eGFR measured in the 1-year period. Measurement rates for uACR were 45.2% for diabetes and 16.5% for hypertension in the 1-year period, and increased to 65.3% and 24.8% using the 3-year measurement period. Rates varied considerably across HCOs for uACR (e.g., 5th and 95th percentiles for the 3-year period were 25.3% and 79.6% among patients with diabetes). When limiting to patients with hypertension but no diabetes, uACR measurement rates were very low, even with eGFR < 60 (i.e., CKD G3+).

Conclusion

Most patients with diabetes or hypertension have eGFR measured, consistent with recommendations from clinical guidelines. uACR measurement rates were moderate and variable across HCOs among patients with diabetes, demonstrating an opportunity for improvement in clinical practice. Measurement rates for uACR were very low for hypertension without diabetes, even in the presence of reduced eGFR.