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Kidney Week

Abstract: PO0509

Factors Associated with Screening and Recognition of CKD in the VA Healthcare System

Session Information

Category: CKD (Non-Dialysis)

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

Authors

  • Bansal, Shweta, The University of Texas Health Science Center at San Antonio Joe R and Teresa Lozano Long School of Mediciine, San Antonio, Texas, United States
  • Mader, Michael J., South Texas Veterans Health Care System, San Antonio, Texas, United States
Background

The successful implementation of interventions to improve kidney disease outcomes requires early identification of CKD which involves screening at-risk population as well as recognizing CKD. We have reported suboptimal detection of proteinuria and documentation of CKD previously and now aim to identify factors associated with these rates.

Methods

We interrogated VISN-17 database for at-risk Veterans with hypertension (HTN) and diabetes seen regularly in primary clinics during 2012-19. The final cohort (N=270,170) charts were analysed for serum creatinine/eGFR, urine protein/albumin, ICD codes for CKD, and nephrology referral. CKD was defined as eGFR <60ml/min at least twice 90 days apart and/or urine albumin creatinine ratio (uACR) of >30 mg/g. Factors were examined which could be associated with screening and recognition.

Results

As shown in table, 94.3% patients had one or other screening procedures done. Urine protein/albumin was present in 56.4% charts, the least in patients with HTN only (40%). CKD by lab evidence was present in 42%; however, only 40% of these had documented ICD-codes for CKD or nephrology referral. There was no clinically significant difference between screened vs. unscreened or recognized vs. unrecognized groups in age, sex, and BMI. Hispanic race associated with decrease screening procedures but no difference in CKD recognition. Patients were more likely to have screening procedures as well documented CKD, if they had heart disease, stroke, cancer; higher frequency of specialty care visits, hospitalizations or ER visits; or elective procedures as vascular and cardiac catheterizations. There was no difference in BP control in screened vs. unscreened group but more patients with documented CKD had BP>140/90mmHg.

Conclusion

Protienuria was detected and CKD was recognized in half of the at-risk Veterans. Co-morbidities and health care visits other than primary care associated with increased screening and recognition suggest utility of initiatives at primary care level to educate the need for CKD detection and awareness.

Funding

  • Veterans Affairs Support