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NEW ORLEANS -- Screening for chronic kidney disease (CKD) may help to improve the care of people who are at high risk for complications, reported a researcher at .
Using electronic health record (EHR) data to randomize nearly 2,000 veterans without a known diagnosis of CKD to receive CKD screening or usual care, researchers found a 20% yield of undetected cases among those screened (95% CI 16-24%), reported Carmen A. Peralta, MD, of the University of California San Francisco, during her presentation on Thursday evening.
Action Points
- Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
"This study is very important because it shows that there is a high prevalence of CKD that is undetected among high risk persons," Peralta told 51˶.
She noted that the study also demonstrated that it's feasible to use the EHR to conduct a randomized trial.
"We were able to identify patients, deliver the intervention and ascertain outcomes, all through the EHR. This is really important because it validates the process of pragmatic trials in the real world using EHR," she explained.
Peralta and colleagues used EHR data to identify 1,819 non-diabetic hypertensive people without known chronic kidney disease who received primary care clinic at the San Francisco VA facility from February 2016 to April 2017. Median patient age was 68, more than half were white (55%), and the majority were male (99%) and had hypertension (99%).
The veterans were cluster-randomized to usual care, chronic kidney disease screening with patient-provider education, or chronic kidney disease screening and education plus clinical pharmacist management. Of the 1,142 veterans who were randomized to intervention, 525 were identified with an upcoming appointment and had CKD screening ordered, with 371 (71%) completing testing.
Chronic kidney disease was identified using creatinine, cystatin C, and albuminuria and was defined as eGFRcreat-cys <60 ml/min/1.73m2 or albumin to creatinine ratio ≥30mg/g.
Overall, proportions of participants who initiated ACE/ARB therapy by the end of the study were 7% for usual care, 9% for the screening and education group, and 10% for the screening, education, and pharmacist group. Proportions who initiated diuretics were 5%, 7%, and 8%, respectively, and NSAID was essentially the same across all three groups.
Peralta stated that one key takeaway was that CKD screening was ordered for less than 50% of intervention patients. She offered several recommendations on how to increase the percentage of patients who receive screening -- including a rolling enrollment, simplifying the consent process, and bulk ordering tests at the beginning of the study.
She concluded that the next step is a larger study: "Otherwise, we cannot know whether screening for CKD, followed by management optimization, can improve clinical outcomes."
Disclosures
Peralta reported receiving funding from the National Institute of Diabetes and Digestive and Kidney Diseases.
Primary Source
ASN Kidney Week 2017
Peralta CA, et al "A pilot pragmatic randomized trial of CKD screening to improve care among hypertensive veterans" ASN 2017; TH-OR 037.