Fewer than 40% of adults with diabetes receive recommended CKD testing
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Key takeaways:
- 32.2% of Medicare fee-for-service beneficiaries received yearly eGFR and urinary albumin-creatinine ratio testing.
- 38.7% of Medicare Advantage beneficiaries fulfilled testing protocols.
Fewer than 40% of adults with diabetes received the clinically recommended testing for chronic kidney disease in 2017, according to a recently published study from the National Kidney Foundation and National Committee for Quality Assurance.
“Diabetes affects more than 34 million U.S. adults and is the leading cause of CKD,” Silvia Ferrè, PhD, senior director of patient outcomes research for the NKF, and colleagues wrote. “Despite the high prevalence ... [approximately] 90% of people with CKD in the United States are unaware of their condition. This fact can be attributed to [its] asymptomatic nature, under-testing and low diagnosis rates, even among high-risk groups.”
Researchers conducted a retrospective cohort study to evaluate the fulfillment and validity of the Kidney Health Evaluation for People with Diabetes (KED), a component of the Healthcare Effectiveness Data Information Set measure, using a national sample from Optum Labs Data Warehouse (OLDW). OLDW includes medical, pharmacy, laboratory and electronic health record data for more than 7 million U.S. adults with diabetes.
The KED assessment serves as a tool for CMS and builds on NKF and American Diabetes Association recommendations.
To meet KED fulfillment criteria, individuals must test for both eGFR and urinary albumin-creatinine ratio (UACR) annually, according to the NKF and the National Committee for Quality Assurance . Investigators tested fulfillment using bivariate analyses with diabetes care measures in 2017 and CKD diagnosis and evidence-based kidney protective interventions in 2018.
According to the findings, 32.2% of Medicare fee-for-service beneficiaries, 38.7% of Medicare Advantage beneficiaries and 37.7% of commercial patients fulfilled the measures. Albuminuria testing revealed primary limitations, the study found, as UACR tests fell below 40% and eGFR testing exceeded 90%.
“A screened population should have greater awareness, be better educated and managed and be better prepared for kidney failure should that occur,” the researchers wrote.
KED fulfillment was positively associated with receiving diabetes care in 2017, CKD diagnosis in 2018 and evidence-based kidney protective interventions in 2018, according to the results. However, researchers observed disparities in meeting these criteria among Black adults, those with Medicare-Medicaid dual eligibility status, residents of low-income neighborhoods and individuals with limited education.
“Kidney health testing is pivotal to ensuring timely diagnosis and equitable treatment of CKD,” Joseph Vassalotti, MD, NKF chief medical officer, wrote in a press release. “We want health care 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.”
Reference:
Only 40% of diabetes patients get recommended kidney health testing. https://www.kidney.org/news/only-40-diabetes-patients-get-recommended-kidney-health-testin Published Aug. 30, 2023. Accessed Sept. 6, 2023.
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