Abstract: SA-PO0448
Proteinuria Screening and Renoprotective Interventions in Hypertensive Patients with and Without Diabetes
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
- Alshamali, Mohammad, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania, United States
- Alqallaf, Ali, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania, United States
- Gillespie, Avrum, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania, United States
Background
Chronic kidney disease (CKD) is a well-known independent risk factor for coronary artery disease. The 2017 AHA guidelines recommend screening with the microalbumin or protein to creatinine ratio in people with hypertension (HTN) as well as people with diabetes mellitus (DM). In this study, we examine the rate of screening patients with HTN both with and without DM and whether they received renoprotective interventions (ACE-I, ARB, SGLT2i) or nephrology referrals in an academic internal medicine clinic.
Methods
We selected all patients from the internal medicine clinic at Temple University Health. System between 2022-23 with HTN . We collected demographic features, age, ethnicity, sex, clinical variables from the EMR. We created and compared two groups patients with DM + HTN vs. patients HTN only. We used t test and and χ2 tests as appropriate. We performed a multivariable logistic regression to examine factors associated with proteinuria screening adding systolic blood pressure and body mass index (BMI) a priori . This research was approved by the Temple IRB.
Results
Our dataset contained 2326 (51%) patients with both DM + HTN, and 2236 (49%) with HTN only. A greater percentage of patients with DM + HTN (24.6%) were screened compared to 13.0% with HTN only arm (p<0.001). Patients with HTN + DM were more likely to be initially on an ACEi or ARB (59.9%) compared to HTN only (48.4%) (p<0.001), and Patients with DM + HTN were more likely to have CKD 26.2% compared to HTN only 14.4% (p<0.001). Those who were screened did not receive more proteinuria lowering medications (8.3% vs. 6.7%; p=0.11) but they were referred to nephrology more often (6.5% vs. 2.4%; p<0.001). Our multivariable model showed that patients with DM (OR 2.13, 95% CI [1.81- 2.51] (p<0.001) and CKD (OR: 1.31, 95% CI [1.1-1.57] ( p<0.003) were more likely to be screened. Systolic Blood pressure and BMI were not associated with ordering a proteinuria screen.
Conclusion
Our findings show that most patients are not being screened. Those with DM and CKD were more likely to be screened, and those who were screened were more likely to be referred. Implementation of targeted system-level interventions, such as electronic health record-based clinical decision support alerts and improved access to home urine testing kits, may increase screening rates and help standardize care for high-risk hypertensive patients.