Point-of-Care Testing and Integrated Digital Health Technology for CKD Screening in High-Risk Populations of India.

INTRODUCTION

Chronic kidney disease (CKD) is a significant contributor to morbidity, mortality, and health care expenditure. Lack of early diagnosis with treatment leads to progression to advanced stages requiring high-cost interventions. The current pilot study examined the feasibility of using point-of-care testing (POCT) and digital health technology for CKD screening.

METHODS

We performed screening in the following 2 populations: (i) 843 persons from high-risk urban (HRU) population with noncommunicable diseases (NCDs), and (ii) 1217 persons from the hotspot CKD of unknown etiology (CKDu) rural (HCR) area population followed up in primary health centers (PHCs) in the Andhra Pradesh state of India. We followed the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines suggesting POCT use for serum creatinine and urinary albumin-to-creatinine ratio (UACR) determination in the settings with limited laboratory access.

RESULTS

Mean age was 54.4 (12.1) years, and 60.9% were female. CKD was identified in 57.5% and 61.8% of the city and rural groups, respectively. The HRU and HCR groups differed in the percentage of estimated glomerular filtration rate (eGFR) grade 4 (4.4% vs. 12.5%) and grade 5 (1.4% vs. 9.8%) and albuminuria grade A2 (8.1% vs. 20.6%) and A3 (12.6% vs. 7.1). In the HCR 48.4% of patients with CKD had no comorbidities. Only 1.4% in the HRU and 16.5% in the HCR groups were aware of existing CKD, even in the presence of multiple CKD risk factors.

CONCLUSION

CKD screening using POCT and digital health technology allowed diagnosis of CKD in patients of high-risk groups and should be scaled up with the final goal to ensure early diagnosis, decrease costs, and improve patients' clinical management.