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Kidney Week

Abstract: PO2355

Increasing Proteinuria Screening to Reduce CKD Progression in High-Risk Patients

Session Information

Category: CKD (Non-Dialysis)

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

Authors

  • Khil, Jaclyn, Kaiser Permanente, Oakland, California, United States
  • Carrillo, Nika, Kaiser Permanente, Oakland, California, United States
  • Ramalingam, Nirmala D., Kaiser Permanente, Oakland, California, United States
  • Tran, H. Nicole, Kaiser Permanente, Oakland, California, United States
  • Zheng, Sijie, Kaiser Permanente, Oakland, California, United States
Background

Chronic Kidney Disease (CKD) affects 15% of the US population and is underrecognized by patients and clinicians. Screening for proteinuria is essential in prompting primary care doctors (PCPs) to initiate treatments proven to decrease progression to end stage renal disease, cardiovascular events and mortality in these patients. However, screening rates remain low -- one study showed only 13% of adults with CKD had proteinuria/albuminuria testing. Our objective was to identify the high-risk patients with CKD who did not recieve annual proteinuria testing, with the long-term goal of addressing barriers to quality care.

Methods

We identified 4214 patients between October and December 2020 within our healthcare system who had a diagnosis of CKD 3 or 4 and categorized them as having diabetes/not having diabetes and having hypertension/not having hypertension. We then assessed how many patients had proteinuria testing in the last year, which included a urinalysis, urine protein to creatinine ratio or urine microalbumin.

Results

Results showed that 100% of patients with diabetes had screening in the last year regardless of CKD stage or hypertension (HTN). For those with CKD3A/HTN only 14% (171/1226) had screening in the last year and for those with CKD3B/HTN only 28% (98/347) had screening in the last year. For patients with CKD3A and CKD3B (without HTN/diabetes), 14% (125/892) and 34% (48/142) respectively had appropriate screening.

Conclusion

Within our large, integrated healthcare system, rates of proteinuria screening in diabetic patients were strikingly high. In contrast, most patients with CKD3 and HTN did not receive testing in the last year. One explanation for this is the workflow in place to help PCPs manage their patients with diabetes, which includes automated reminders and a dedicated multidisciplinary team. Applying a similar systematic, protocol-based workflow to all patients with CKD may help to increase screening rates and improve overall quality of care.