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Only 40% of diabetes patients get recommended kidney health testing

Study Reveals Alarming Disparities in Chronic Kidney Disease Testing and Highlights Path to Equitable Care for Americans living with Diabetes 

Not enough diabetes patients are getting their recommended kidney health screenings, according to a new study by the National Kidney Foundation (NKF) and the National Committee for Quality Assurance (NCQA).

According to new data published in Mayo Clinic Proceedings: Innovations, Quality & Outcomes journal, less than 40% of patients with diabetes have been recommended at least annual kidney health screening tests. Diabetes raises the risk of chronic kidney disease (CKD), a serious condition that often remains asymptomatic until reaching an advanced stage. Additionally, NKF and NCQA found concerning disparities in even lower fulfillment of recommended testing among Black/African Americans and socioeconomically disadvantaged groups, underscoring the urgent need to address these disparities to ensure equitable care for all. NKF is calling on health professionals to prioritize kidney health screening for individuals with diabetes which is pivotal to ensuring timely diagnosis and equitable treatment of CKD.

At the heart of addressing this concerning issue lies the Kidney Health Evaluation Measure for People with Diabetes (KED), jointly developed by NKF and NCQA. Operating as a pivotal component of the Healthcare Effectiveness Data and Information Set (HEDIS), KED serves as a tool for the Centers for Medicare & Medicaid Services (CMS) to pinpoint areas for improvement and set achievable targets for enhanced care.

The study, a collaborative effort between NKF and NCQA, looked at CKD testing based on KED criteria, examining data from a vast OptumLabs Data Warehouse encompassing over 7 million adults with diabetes. This analysis was made possible in part by a grant from the AARP Quality Measure Innovation program. Using claims and electronic health records data, researchers made several key findings, including:

  • Less than 40% of adults with diabetes received guideline-recommended testing for CKD in 2017 with low uACR testing as the primary limitation.
  • There was lower KED fulfillment in Black/African Americans and socioeconomically disadvantaged groups (Medicare-Medicaid dually eligible, lower neighborhood income, lower neighborhood education status) demonstrating disparity in lower testing for albuminuria.
  • KED fulfillment was associated with improved diabetes care, CKD diagnosis, evidence-based drug prescriptions for CKD, blood pressure and blood sugar control, and interdisciplinary care.

“Kidney health testing is pivotal to ensuring timely diagnosis and equitable treatment of CKD,” addedJoseph Vassalotti, MD, NKF Chief Medical Officer.“Based on this knowledge, we want healthcare professionals, policymakers, and communities to use KED guidance as an important step in the roadmap to counter the significant public health challenge posed by undetected and untreated CKD.”

            KED is built on the American Diabetes Association (ADA) and NKF recommendations. It requires that people with diabetes be tested for kidney disease at least annually using both a blood test to measure kidney function [or estimated glomerular filtration rate (eGFR)] and a urine albumin test to measure kidney damage [or urine albumin-creatinine ratio (uACR)]. Additionally, the study highlights concerning disparities in KED fulfillment among Black/African Americans and socioeconomically disadvantaged groups, underscoring the urgent need to address these disparities to ensure equitable care for all.

            In the face of these findings, NKF is urging health care professionals to prioritize CKD testing for individuals with diabetes, as outlined by KED. Approximately 90% of people with CKD in the United States don’t even know they have it.

            “Lack of awareness among practitioners of the importance of routine kidney health evaluation in high-risk populations is an obstacle to patient engagement,” added Silvia Ferrè, PhD, Senior Director, Patient Outcomes Research at the NKF, “Timely diagnosis of CKD in people at risk will allow them to receive early support and education. NKF can connect people with CKD to a variety of patient programs, such as the NKF Patient Network, to empower them through education, peer-support, and participation in research.”

 Ultimately, professional education about guideline-recommended testing for CKD among people with diabetes should lead to timely and equitable CKD diagnosis and people-centered care.

The full study can be found here: https://www.sciencedirect.com/science/article/pii/S2542454823000413

The video describing the study can be found here: https://www.youtube.com/watch?v=0bMKLRBbIzI

About Kidney Disease

In the United States, 37 million adults are estimated to have kidney disease, also known as chronic kidney disease (CKD)—and approximately 90 percent don’t know they have it.  About 1 in 3 adults in the U.S. are at risk for kidney disease.  Risk factors for kidney disease include: diabeteshigh blood pressureheart diseaseobesity, and family history. People of Black or African American, Hispanic or Latino, American Indian or Alaska Native, Asian American, or Native Hawaiian or Other Pacific Islander descent are at increased risk for developing the disease. Black or African American people are more than four times as likely as White Americans to have kidney failure. Hispanics experience kidney failure at about double the rate of White people.

About the National Kidney Foundation

The National Kidney Foundation (NKF) is the largest, most comprehensive, and longstanding patient-centric organization dedicated to the awareness, prevention, and treatment of kidney disease in the U.S. For more information about NKF, visit www.kidney.org.

About Mayo Clinic Proceedings: Innovations, Quality & Outcomes
The journal is fully open access, meaning that anyone with an internet connection anywhere in the world can access and read this article for free. The journal is sponsored by Mayo Clinic and published by Elsevier.

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