Laboratory Corporation of America Holdings, Burlington, NC
Laboratory Corporation of America Holdings, Burlington, NC.
Diabetes Care. 2021 Sep;44(9):2025-2032. doi: 10.2337/dc21-0723. Epub 2021 Aug 5.
An estimated 37 million Americans have chronic kidney disease (CKD). Nearly 90% do not know about their condition because of low awareness about the importance of CKD testing and diagnosis among practitioners and people at risk for CKD. This study uses data from a national clinical laboratory to identify guideline-recommended CKD testing rates across the U.S.
Patients with Laboratory Corporation of America Holdings (Labcorp) testing between 2013 and 2019 were defined as at risk for CKD if they had any testing ordered with diagnosis codes for diabetes and/or hypertension. Guideline-concordant CKD assessment was defined by estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (uACR) testing within the study year.
We identified 28,295,982 at-risk patients (mean age 60.6 ± 14.8 years; 53.6% women): 16.2% had diabetes, 63.8% had hypertension, and 20.1% had both comorbidities. Of these, 80.3% did not receive guideline-concordant assessment during the study period. Furthermore, only 21.0% had uACR testing versus 89.6% with eGFR. CKD assessment occurred at least once in 28.7% of patients with diabetes, 10.5% of patients with hypertension, and 41.4% of patients with both conditions. In a state-by-state comparison, annual testing rates ranged from 5 to 30%. The nationwide rate increased modestly each year between 2013 and 2018 (from 10.7% to 15.2%).
Despite guideline recommendations, testing for CKD with uACR and eGFR in U.S. adults with diabetes and hypertension is low in routine clinical care. These data highlight the need for strategies to improve routine CKD assessment nationwide.
据估计，有 3700 万美国人患有慢性肾脏病（CKD）。由于医生和 CKD 高危人群对 CKD 检测和诊断的重要性认识不足，近 90%的患者不知道自己的病情。本研究利用美国一家全国性临床实验室的数据，确定了全美范围内符合指南建议的 CKD 检测率。
如果 2013 年至 2019 年在美国实验室公司控股（Labcorp）进行过检查的患者有任何诊断为糖尿病和/或高血压的检测，则将其定义为 CKD 高危人群。如果在研究年度内进行了估计肾小球滤过率（eGFR）和尿白蛋白/肌酐比（uACR）检测，则将其定义为符合指南的 CKD 评估。
我们确定了 28295982 名高危患者（平均年龄 60.6±14.8 岁；女性占 53.6%）：16.2%患有糖尿病，63.8%患有高血压，20.1%同时患有这两种疾病。其中，80.3%的患者在研究期间未接受符合指南的评估。此外，只有 21.0%的患者进行了 uACR 检测，而 89.6%的患者进行了 eGFR 检测。在患有糖尿病的患者中，28.7%至少进行过一次 CKD 评估，10.5%患有高血压的患者进行了评估，41.4%同时患有这两种疾病的患者进行了评估。在各州之间的比较中，每年的检测率在 5%至 30%之间。2013 年至 2018 年，全美范围内的检测率每年略有上升（从 10.7%升至 15.2%）。
尽管有指南建议，但在美国患有糖尿病和高血压的成年人中，常规临床护理中使用 uACR 和 eGFR 检测 CKD 的比例仍然较低。这些数据突显了在全国范围内实施策略以改善常规 CKD 评估的必要性。
