Kidney Week

Abstract: SA-PO0445

Frequency of Urine Albumin Monitoring Among US Veterans with Albuminuria

Session Information

• CKM: Clinical - Screening, Population Management, Care Disparities, and Patient-Centered Outcomes
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Cardiovascular-Kidney-Metabolic Health

• 602 Cardiovascular-Kidney-Metabolic Health: Clinical

Authors

• Ikeme, Jesse C., University of California San Francisco, San Francisco, California, United States

Jesse C. Ikeme, MD

• Madden, Erin, University of California San Francisco, San Francisco, California, United States

Erin Madden, MPH

• Shlipak, Michael G., University of California San Francisco, San Francisco, California, United States

Michael G. Shlipak, MD, MPH

• Lamprea Montealegre, Julio Alejandro, University of California San Francisco, San Francisco, California, United States

Julio Alejandro Lamprea Montealegre, MD, PhD

• Beller Ferri, Mauricio, Bayer Corporation, Whippany, New Jersey, United States

Mauricio Beller Ferri, MD, MS, MSc

• Katta, Arvind, Bayer Corporation, Whippany, New Jersey, United States

Arvind Katta, PharmD, MS

• Earl, Jacob, Bayer Corporation, Whippany, New Jersey, United States

Jacob Earl, PharmD, MS

• Zheng, Zihe, Bayer Corporation, Whippany, New Jersey, United States

Zihe Zheng, MBBS, MS, PhD, FASN

• Wang, Yunxun, Bayer Corporation, Whippany, New Jersey, United States

Yunxun Wang, MS, MSc

• Aldworth, Carolina A R, Bayer Corporation, Whippany, New Jersey, United States

Carolina A R Aldworth, MD, MS, MBA

• Estrella, Michelle M., University of California San Francisco, San Francisco, California, United States

Michelle M. Estrella, MD

Background

Persistently elevated urine albumin identifies persons who would benefit from guideline-directed therapies to prevent chronic kidney disease (CKD) progression and cardiovascular events. We aimed to characterize patterns in urine albumin-to-creatinine ratio (UACR) monitoring among a nationwide cohort of veterans with albuminuria.

Methods

This retrospective cohort study used electronic health record data from US veterans receiving care within Veterans Affairs health care systems. Among those with UACR ≥30 mg/g between 2022 and 2023, we estimated the associations of patient and system characteristics with the frequency of repeat UACR testing in the following two years using a mixed-effects negative binomial model.

Results

Among 164,402 veterans with UACR ≥30 mg/g and type 2 diabetes, median (IQR) eGFR was 66 (49-85) ml/min/1.73 m², and median UACR was 95 (50-249) mg/g. Repeat UACR tests were obtained in 83%, with a mean (SD) of 1.91 (1.76) tests over two years. Mean tests per year ranged from 0.9 to 1.7 across CKD stages (Figure). Hypertension (adjusted rate ratio 1.13; 95% CI 1.12-1.15); receipt of endocrinology (1.12; 1.10-1.13) and nephrology (1.65; 1.63-1.66) care, lower eGFR categories, and UACR >300 mg/g (1.08; 1.07-1.09) were associated with more frequent testing. After accounting for individual-level characteristics, the median rate ratio between individuals from any two health care systems was 1.23, suggesting substantial between-system variation. Health care systems with higher rates of influenza vaccination, an indicator of care quality, had more frequent testing (1.19; 1.13-1.25).

Conclusion

Urine albumin monitoring in veterans with albuminuria varies with patient characteristics and between health care systems. Overall, testing frequency falls short of risk-based recommendations.

Funding

• Commercial Support – Bayer