Abstract: TH-PO1229
Clinical Decision Support Triggers to Improve CKD Screening and Detection in Primary Care: The ALMA-CKD Pragmatic Cluster Randomized Trial
Session Information
- Late-Breaking Research Posters
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Artificial Intelligence, Digital Health, and Data Science
- 300 Artificial Intelligence, Digital Health, and Data Science
Authors
- Créon, Antoine, Karolinska Institutet, Stockholm, Sweden
- Andersson Emad, Jacob, Karolinska Institutet, Stockholm, Sweden
- Nash, Stephen, Karolinska Institutet, Stockholm, Sweden
- Thunholm, Arvid, Blackwell Medtech, Stockholm, Sweden
- Evans, Marie, Karolinska Institutet, Stockholm, Sweden
- Fu, Edouard, Karolinska Institutet, Stockholm, Sweden
- Lind af Hageby, Sara, Karolinska Universitetssjukhuset, Stockholm, Sweden
- Sjölander, Arvid, Karolinska Institutet, Stockholm, Sweden
- Jacobson, Stefan H., Danderyds Sjukhus, Stockholm, Sweden
- Carrero, Juan Jesus, Karolinska Institutet, Stockholm, Sweden
Group or Team Name
- ALMA-CKD Trial Investigators.
Background
CKD detection in primary care is hindered by low screening rates. Electronic clinical decision support (CDS) triggering systems may offer a scalable solution, but their effectiveness in routine practice is unknown.
Methods
In this pragmatic cluster-randomized trial (NCT06386172), 65 primary care centers in Stockholm, Sweden, were randomized 1:1 to CKD-specific CDS triggers embedded into electronic health records, or to standard care. Triggers gave individualized guidance on guideline-recommended screening, retesting, diagnosis and management. The primary outcomes were creatinine and albuminuria testing within 12 months in patients indicated for annual screening. The secondary outcome was repeat testing within 6 months of an abnormal result (i.e. eGFR<60 ml/min/1.73 m2 or albuminuria>30 mg/L). Analysis was conducted at both the individual (risk ratio, RR) and cluster (risk difference, RD) level and was adjusted for randomization strata of cluster size and each center's 2019 testing rates.
Results
Among 28,438 patients indicated for creatinine screening, creatinine testing rates ranged from 28% to 89% across centers (Figure), with no difference by intervention (RR 1.02; 95% CI 0.88-1.18 and RD 1.8; 95% CI -6.5,10.1, Table). Among 63,122 patients indicated for albuminuria screening, albuminuria testing rates ranged from 17% to 71%, also without difference (RR 1.07; 0.94-1.23 and RD 3.9; -2.0,9.8). Among 4036 patients with newly detected abnormal values, retesting rates did not differ between arms either. Usage data indicated low physician engagement with the trigger system.
Conclusion
CKD screening and retesting rates among patients with guideline-based indications were low, and a dedicated CDS triggering system integrated into primary care did not improve this pattern.
| Standard care tested/total | CDS triggers tested/total | Risk Ratio (95% CI) | Risk difference, pp (95% CI) | |
| Creatinine screening test | 9,094/14,014 (64.9%) | 8,910/14,424 (61.8%) | 1.02 (0.88-1.18) | 1.8 (-6.5;10.1) |
| Albuminuria screening test | 15,251/33,008 (46.2%) | 14,323/30,114 (47.6%) | 1.07 (0.94-1.23) | 3.9 (-2.0;9.8) |
| Creatinine re-test | 833/1,569 (53.1%) | 868/1,652 (52.5%) | 0.98 (0.89-1.08) | -1.0 (-6.3; 4.3) |
| Albuminuria re-test | 927/2,467 (37.6%) | 869/2,318 (37.5%) | 1.01 (0.91-1.11) | 0.4 (-3.3; 4.0) |
Funding
- Commercial Support – Investigator-driven study funded by the Stockholm's healthcare system and an unrestricted grant to Karolinska Institutet from AstraZeneca and Boehringer