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Kidney Week

Abstract: PO0504

Increased Urinary Albumin Creatinine Testing in CKD Stage 3 and Effect on Quality Metrics

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Park, Ken J., Kaiser Permanente Northwest, Portland, Oregon, United States
  • Thorp, Micah L., Kaiser Permanente Northwest, Portland, Oregon, United States
  • Unitan, Robert, Kaiser Permanente Northwest, Portland, Oregon, United States
Background

One of the goals of Advancing American Kidney Health Initiative is “reducing the number of Americans developing End Stage Renal disease by 25% by 2030.” An important part in achieving this goal is increased use of interventions backed by high quality evidence including use of ACE inhibitors or ARBs, control of hypertension, and diabetes (DM) control. Albuminuria has been clearly linked to CKD progression, but evidence is lacking as to whether more frequent monitoring slows CKD progression. We were interested in whether more frequent monitoring of albuminuria via automated testing improved CKD quality metrics.

Methods

This was a cross sectional study using a CKD registry in Kaiser Permanente Northwest. The CKD registry was population-based which did not require patient consent. We compared urinary albumin creatine (ACR) testing, filled ACE inhibitor and ARB prescriptions, DM control (hgba1c < 8%), and hypertension control (blood pressure <140/90) at one time point before and 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. Primary care providers received an received an alert in the electronic health record (EHR) for those patients not on an ACE inhibitor or ARB who had a renal indication. Renal indications for an ACE inhibitor or ARB were hypertension and an ACR > 30 mg/g with DM or an ACR > 300 mg/g without DM.

Results

There were 10,335 patients in the CKD registry on 12/5/2017 and 10,515 on 12/5/2019. Average age was 73, 81% had hypertension, 38% had DM, and 44% were male. Automated ACR testing in patients with stage 3 CKD was implemented on 5/23/2018. One and half years after implementation of ACR testing, ACR testing increased from 26% to 61% (p < 0.001). ACE inhibitor or ARB use among patients with renal indication did not increase significantly (79% vs. 81%, p = 0.08). Control of DM increased (78% vs. 81%, p < 0.001) while control of hypertension worsened (76% vs. 74%, p = 0.001).

Conclusion

In patients with stage 3 CKD, increased albuminuria testing via automated testing linked with EHR alerts did not results in an overall improvement in CKD quality metrics. However, our study was limited by the cross-sectional design as well as the short follow up.