Kidney Week

Abstract: FR-OR043

Diagnostic Inertia in CKD: Delayed Recognition of Abnormal Kidney Biomarkers in a Large Real-World Electronic Health Record Cohort

Session Information

• Exciting Developments in CKD Research: From Diagnostics to Management and More
  October 23, 2026 | Location: Mile High Ballroom 1D, Convention Center
  Abstract Time: 05:30 PM - 05:40 PM

Category: CKD (Non-Dialysis)

• 2202 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Shril, Shirlee, Natera Inc, Austin, Texas, United States

Shirlee Shril

• Chapman, Maksim S., Natera Inc, Austin, Texas, United States

Maksim S. Chapman

• Kaur, Navchetan, Natera Inc, Austin, Texas, United States

Navchetan Kaur, PhD

• Doud, Andrew C., Natera Inc, Austin, Texas, United States

Andrew C. Doud

• Prewett, Adam, Natera Inc, Austin, Texas, United States

Adam Prewett

• Chang, Alexander R., Geisinger Health, Danville, Pennsylvania, United States

Alexander R. Chang, MD, MS

• Bhorade, Sangeeta, Natera Inc, Austin, Texas, United States

Sangeeta Bhorade, MD

• Schneider, Ronen, Natera Inc, Austin, Texas, United States

Ronen Schneider, MD

Background

Persistent abnormal biomarkers frequently signal CKD, but formal diagnosis is often substantially delayed. Current diagnostic pathways react to functional decline rather than proactively evaluating the underlying cause. We quantify time from initial abnormal renal biomarkers to definitive CKD diagnosis in a large, real-world cohort.

Methods

We retrospectively analyzed 4.1 million patients in Vanderbilt University Medical Center's Synthetic Derivative database (Nashville Biosciences®). Patients were screened for persistent kidney disease indicators (abnormal labs ≥90 days apart), including eGFR <90 mL/min/1.73m², proteinuria positivity, microhematuria, UACR>30, UPCR>0.3, and ICD-10 diagnoses indicating kidney disease. For patients meeting these criteria, we evaluated time from first abnormal biomarker to documented CKD ICD-10 diagnosis.

Results

Of 4,146,967 patients, 540,738 (13.0%) met criteria for persistent kidney disease indicators. Among these, median time from abnormal biomarker detection to formal CKD ICD-10 diagnosis was 1937 days (~5.3 years; IQR: 524-4078 days [for eGFR<60 mL/min/1.73m², median delay was 3.2 years]); mean delay, 2571 days (~7.0 years); (Figure). During the 2 years before diagnosis, kidney function declined measurably: median eGFR decreased from 75.0 to 66.0 mL/min/1.73 m² between early and late pre-diagnosis windows. Median delays varied by biomarker: UACR (2.7 years), with eGFR markers showing the longest delays (5.3 years).

Conclusion

In a large real-world cohort, formal CKD diagnosis frequently lagged (>3 years in a majority of patients) behind initial persistent abnormal renal biomarkers, with measurable kidney function decline occurring before documented recognition. This diagnostic inertia highlights an opportunity for earlier risk stratification and intervention.

Funding

• Commercial Support – Natera, Inc.