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Chronic Kidney Disease Testing Among Primary Care Patients With Type 2 Diabetes Across 24 U.S. Health Care Organizations
Open accessAbstract
OBJECTIVE: Clinical guidelines for people with diabetes recommend chronic kidney disease (CKD) testing at least annually using estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (uACR). We aimed to understand CKD testing among people with type 2 diabetes in the U.S. RESEARCH DESIGN AND METHODS: Electronic health record data were analyzed from 513,165 adults with type 2 diabetes receiving primary care from 24 health care organizations and 1,164 clinical practice sites. We assessed the percentage of patients with both one or more eGFRs and one or more uACRs and each test individually in the 1, 2, and 3 years ending September 2019 by health care organization and clinical practice site. Elevated albuminuria was defined as uACR ≥30 mg/g. RESULTS: The 1-year median testing rate across organizations was 51.6% for both uACR and eGFR, 89.5% for eGFR, and 52.9% for uACR. uACR testing varied (10th–90th percentile) from 44.7 to 63.3% across organizations and from 13.3 to 75.4% across sites. Over 3 years, the median testing rate for uACR across organizations was 73.7%. Overall, the prevalence of detected elevated albuminuria was 15%. The average prevalence of detected elevated albuminuria increased linearly with uACR testing rates at sites, with estimated prevalence of 6%, 15%, and 30% at uACR testing rates of 20%, 50%, and 100%, respectively. CONCLUSIONS: While eGFR testing rates are uniformly high among people with type 2 diabetes, testing rates for uACR are suboptimal and highly variable across and within the organizations examined. Guideline-recommended uACR testing should increase detection of CKD.
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“Screening is underutilized, particularly for albuminuria. In typical practice in the U.S., less than half of patients with T2D are screened for albuminuria in a given year (19).”
From Diabetes management in chronic kidney disease: a consensus report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) (2022) · cites this paper as [19]
Experimental — accuracy not yet measuredIn the citing paper
“In a recent analysis of electronic health record data from 1164 clinical practices including over 500,000 adults with T2D in primary care clinics, the testing for eGFR was 89.5%, UACR 52.9%, and only 51.6% for both tests at a median of 1 year [10].”
From Glucagon-like peptide-1 receptor agonists in diabetic kidney disease: a review of their kidney and heart protection (2023) · cites this paper as [10]
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Cites
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A New Equation to Estimate Glomerular Filtration Rate
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Self-citationCanagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy
Perkovic, V., Jardine, M. J., Neal, B., Bompoint, S., Heerspink, H. J. L., Charytan, D. M., Edwards, R., Agarwal, R., Bakris, G., Bull, S., et al. (2019) · New England Journal of Medicine · doi:10.1056/nejmoa1811744 · Cited by 6,189
Stevens, P. E., Levin, A., & for the Kidney Disease: Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group Members* (2013) · Annals of Internal Medicine · doi:10.7326/0003-4819-158-11-201306040-00007 · Cited by 3,607
A Note on Robust Variance Estimation for Cluster‐Correlated Data
Williams, R. L. (2000) · Biometrics · doi:10.1111/j.0006-341x.2000.00645.x · Cited by 2,501
Inker, L. A., Astor, B. C., Fox, C. H., Isakova, T., Lash, J. P., Peralta, C. A., Tamura, M. K., & Feldman, H. I. (2014) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2014.01.416 · Cited by 1,828
KDOQI clinical practice guideline for diabetes and CKD: 2012 update
(2012) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2012.07.005 · Cited by 1,320
Clinical manifestations of kidney disease among US adults with diabetes, 1988-2014
Afkarian, M., Zelnick, L. R., Hall, Y. N., Heagerty, P. J., Tuttle, K., Weiss, N. S., & de Boer, I. H. (2016) · JAMA · doi:10.1001/jama.2016.10924 · Cited by 1,026
US Renal Data System 2019 Annual Data Report: Epidemiology of Kidney Disease in the United States
Saran, R., Robinson, B. M., Abbott, K. C., Bragg‐Gresham, J. L., Chen, X., Gipson, D. S., Gu, H., Hirth, R. A., Hutton, D. W., Jin, Y., et al. (2019) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2019.09.003 · Cited by 993
9. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes—2021
American Diabetes Association (2021) · Diabetes Care · doi:10.2337/dc21-s009 · Cited by 972
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Development and validation of the American Heart Association’s PREVENT equations
Khan, S. S., Matsushita, K., Sang, Y., Ballew, S. H., Grams, M. E., Surapaneni, A., Blaha, M. J., Carson, A. P., Chang, A. R., Ciemins, E., et al. (2024) · Circulation · doi:10.1161/circulationaha.123.067626 · Cited by 1,234
Self-citationde Boer, I. H., Khunti, K., Sadusky, T., Tuttle, K. R., Neumiller, J. J., Rhee, C. M., Rosas, S. E., Rossing, P., & Bakris, G. (2022) · Diabetes Care · doi:10.2337/dci22-0027 · Cited by 919
“In typical practice in the US, less than half of patients with T2D are screened for albuminuria in a given year.(19) Clinical laboratories routinely report eGFR calculated from serum creatinine and demographic data.”
BackgroundEpidemiology and risk of cardiovascular disease in populations with chronic kidney disease
Matsushita, K., Ballew, S. H., Wang, A. Y.-M., Kalyesubula, R., Schäeffner, E., & Agarwal, R. (2022) · Nature Reviews Nephrology · doi:10.1038/s41581-022-00616-6 · Cited by 728
Self-citationde Boer, I. H., Khunti, K., Sadusky, T., Tuttle, K. R., Neumiller, J. J., Rhee, C. M., Rosas, S. E., Rossing, P. R., & Bakris, G. L. (2022) · Kidney International · doi:10.1016/j.kint.2022.08.012 · Cited by 389
Albuminuria: An Underappreciated Risk Factor for Cardiovascular Disease
Barzilay, J. I., Farag, Y. M. K., & Durthaler, J. M. (2024) · Journal of the American Heart Association · doi:10.1161/jaha.123.030131 · Cited by 186
Metadata
- Authors
- Stempniewicz, N., Vassalotti, J. A., Cuddeback, J. K., Ciemins, E., Storfer-Isser, A., Sang, Y., Matsushita, K., Ballew, S. H., Chang, A. R., Levey, A. S., Bailey, R. A., Fishman, J., & Coresh, J.
- Affiliations
- American Medical Group Association (US)
- National Kidney Foundation (US)
- National Committee for Quality Assurance, Washington, DC
- Johns Hopkins University (US)
- Geisinger Medical Center (US)
- Tufts Medical Center (US)
- Janssen Scientific Affairs (United States) (US)
- Corresponding author
- Stempniewicz, Nikita
- ORCID
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2021-07-07
- Volume
- 44
- Issue
- 9
- Pages
- 2000-2009
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC8740923
- OpenAlex
- W3178715673
- Cited by
- 157
- References
- 36
- Citations by year
- 2026: 23 · 2025: 59 · 2024: 25 · 2023: 19 · 2022: 21 · 2021: 9
- FWCI
- 12.65
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Diabetes Care (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
- Keywords
- chronic kidney disease, type 2 diabetes, estimated glomerular filtration rate, albumin-creatinine ratio, albuminuria, CKD screening, guideline adherence, primary care
- MeSH terms
- Adult, Albuminuria, Creatinine, Delivery of Health Care, Diabetes Mellitus, Type 2, Glomerular Filtration Rate, Humans, Primary Health Care, Renal Insufficiency, Chronic
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