Fewer than one-fourth of patients with type 2 diabetes (T2D) undergo recommended screening for chronic kidney disease (CKD), reports a study in JAMA Network Open.
The retrospective analysis included 316,234 adults without known CKD who made an outpatient visit related to T2D from 2015 through 2020. Patients were seen at 20 health care systems participating in The National Patient-Centered Clinical Research Network (PCORnet). The median age was 59 years; approximately one-third of patients were Black (21.7%) and Hispanic (10.3%).
The study focused on concordance with CKD screening guidelines, defined as the measurement of creatinine and the urine albumin-creatinine ratio. Among patients who tested positive for CKD, prescriptions of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers and sodium-glucose cotransporter-2 (SGLT2) inhibitors were assessed.
Only 24.9% of patients with T2D underwent measurement of both creatinine and the urine albumin-creatinine ratio. One of the two screening tests, usually a creatinine measurement, was performed in 56.5% of patients. Neither test was performed in 18.6% of patients.
Screening nonconcordance was more likely for Hispanic patients (relative risk, 1.16). Women and older patients were more likely to undergo screening, as were patients with heart failure, peripheral arterial disease, or hypertension.
Among 4215 patients with CKD and albuminuria, 78.0% were prescribed an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, whereas 4.6% received an SGLT2 inhibitor. Twenty-one percent of patients with CKD received neither treatment. Treatment was less likely for patients with peripheral arterial disease and lower kidney function and was more likely for those prescribed a diuretic or statin or diagnosed with hypertension.
Annual CKD screening is recommended for people with T2D. Low screening rates contribute to underdiagnosis and undertreatment of CKD in this high-risk population.
Adding to previous evidence, this analysis of data contributed to PCORnet showed inadequate adherence to guideline-recommended CKD screening in adults with T2D. The study also found that more than 20% of patients with CKD received no recommended treatments, including “a paucity of SGLT2 inhibitor prescriptions.” Identification of demographic and clinical factors associated with CKD screening and treatment has implications for strategies to improve concordance with recommended screening [Edmonston D, et al. Concordance with screening and treatment guidelines for chronic kidney disease in type 2 diabetes. JAMA Netw Open 2024; 7:e2418808. doi: 10.1001/jamanetworkopen.2024.18808].
