Abstract: PO0767
Adequacy of Laboratory Monitoring of CKD for Diabetic Patients Empaneled with Primary Care
Session Information
- Diabetic Kidney Disease: Clinical
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Diabetic Kidney Disease
- 602 Diabetic Kidney Disease: Clinical
Authors
- Thorsteinsdottir, Bjoerg, Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Hickson, LaTonya J., Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Giblon, Rachel, Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Hickman, Joel A., Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Norby, Suzanne M., Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Rule, Andrew D., Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Albright, Robert C., Mayo Clinic Minnesota, Rochester, Minnesota, United States
Background
Studies have shown poor adherence to chronic kidney disease (CKD) guideline adherence in primary care, contributing to late referral to nephrology and suboptimal clinical outcomes. We sought to assess the performance of our health system in adhering to laboratory monitoring guidelines for diabetic patients with laboratory confirmed CKD.
Methods
We identified all adult patients empaneled in a regional health system who had creatinine and urinary albumin measurements between 2014-2016 excluding pregnant patients, as well as those transplanted or already on dialysis or hospice and crossed this cohort with our existing diabetic patient registry. CKD defined based on calculated GFR and CKD risk defined per the Kidney Disease Improving Global Outcomes (KDIGO) guidelines. We defined laboratory monitoring compliance as meeting the number of creatinine measurements recommended by KDIGO per year with at least 3 months between measurement.
Results
27943 diabetic patients had laboratory measurements allowing us to assess their CKD status. Of those 18466 (57%) had low risk/no CKD. Of those meeting CKD criteria, 13966 (50%) were missing a measure of albuminuria, 8030 (28.7%) had moderate, 3563 (12.8%) high and 2384 (8.5%) CKD risk. Compliance with laboratory monitoring was 82.7% for moderate risk, 59.9% for high risk and 44.8% of very high risk patients. Limitations include potential for access to disease monitoring outside of our health system.
Conclusion
Diabetic patients with CKD empaneled in our health system were often not adequately risk stratified for their CKD due to lack of attention to the need for albuminuria measures. For those who could be risk stratified, monitoring for low and moderate risk patients was adequate but the patients in the higher risk categories had worse guideline adherence. Better decision support systems are needed to improve kidney care for this high risk population.
Funding
- NIDDK Support