American Diabetes Association
CKD_Testing_in_T2DM_Online-Supplementary_Materials-REV2-2020-03-30.pdf (1.39 MB)

Chronic Kidney Disease Testing Among Primary Care Patients With Type 2 Diabetes Across 24 U.S. Health Care Organizations

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posted on 2021-07-07, 20:10 authored by Nikita Stempniewicz, Joseph A. Vassalotti, John K. Cuddeback, Elizabeth Ciemins, Amy Storfer-Isser, Yingying Sang, Kunihiro Matsushita, Shoshana H. Ballew, Alex R. Chang, Andrew S. Levey, Robert A. Bailey, Jesse Fishman, Josef Coresh
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-creatinine ratio (uACR). We aimed to understand CKD testing among people with type 2 diabetes in the United States.

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 ≥1 eGFR and ≥1 uACR, 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 by 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%.

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.


Janssen provided financial support to AMGA for the conduct of the research and preparation of the manuscript. R.A.B. and J.F. are employees of the sponsor, Janssen. The sponsor provided input on the analytic plan, interpretation of the data, and review and approval of the manuscript via these authors. The sponsor did not participate in the study concept and design, or the data collection.