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Kidney Week

Abstract: PO2321

Facility-Level Variation and Racial Disparities in Albuminuria and Serum Creatinine Dual Testing in the US Veterans Health Administration (VHA) Health Care System

Session Information

Category: CKD (Non-Dialysis)

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

Authors

  • Han, Yun, University of Michigan, Ann Arbor, Michigan, United States
  • Bhave, Nicole, University of Michigan, Ann Arbor, Michigan, United States
  • Steffick, Diane, University of Michigan, Ann Arbor, Michigan, United States
  • Zivin, Kara, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, United States
  • Koyama, Alain, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
  • Pavkov, Meda E., Centers for Disease Control and Prevention, Atlanta, Georgia, United States
  • Powe, Neil R., University of California San Francisco, San Francisco, California, United States
  • Tuot, Delphine S., University of California San Francisco, San Francisco, California, United States
  • Saran, Rajiv, University of Michigan, Ann Arbor, Michigan, United States
Background

Simultaneous urine testing for albumin (UAlb) and serum creatinine (SCr), i.e., ‘dual testing’, is now an accepted quality measure in the management of diabetes. As kidney disease is defined by both UAlb and SCr testing, this approach could be more widely adopted in kidney care. We therefore sought to assess facility-level variation and racial differences in performance of dual testing in the integrated VHA health care system.

Methods

We included patients with any inpatient or outpatient visit to the VHA during the period 2009-2018. Dual testing was defined as UAlb and SCr testing in the outpatient setting within a fiscal year. A generalized linear mixed-effects model was applied to explore individual level (demographics and comorbidities) and facility level predictors of receiving dual testing.

Results

We analyzed data from approximately 6 million veterans per year (total n=69,102,389; 91.1% male). Dual testing increased on average from 17% to 21%, but varied substantially among VHA centers (0.3% to 43.7% in 2018) (Figure). Dual testing was strongly associated with diabetes (odds ratio [OR]: 10.4, 95% CI 10.3-10.5, p<0.0001) and not associated with VHA center complexity level. Despite a higher proportion of Black veterans receiving dual testing compared to White veterans (24.0% vs 21.7% in 2018), they were less likely to be tested after adjusting for other individual and facility characteristics (OR: 0.93, 95% CI 0.92-0.93, p<0.0001).

Conclusion

Performance of dual testing varied among VHA centers and is low in both White and Black veterans. Simultaneously incorporating UAlb and SCr for kidney care may help improve both risk stratification and management of individuals with or at risk of kidney disease.

Funding

  • Other U.S. Government Support