Schultz Megan, Laue Katelyn, Bryer Nicole, Bzowyckyj Andrew, Java Anuja, Lake Leslie, Talbot-Montgomery Elizabeth, Sovic Brit, Watson Bri'Anna, Vassalotti Joseph A
National Kidney Foundation, New York, NY, USA.
Affinia Healthcare, St. Louis, MO, USA.
J Prim Care Community Health. 2025 Jan-Dec;16:21501319251358923. doi: 10.1177/21501319251358923. Epub 2025 Jul 28.
Chronic Kidney Disease (CKD) affects 1 in 7 adults in the United States, yet 90% of those impacted remain unaware of their condition, and fewer than 20% of at-risk individuals are appropriately tested. Safety-net health care settings are disproportionately burdened by CKD, with a patient population enriched for CKD risk factors, social deprivation, and barriers to diagnostic testing which delay access to diagnosis and lifesaving interventions. The National Kidney Foundation partnered with a Federally Qualified Health Center (FQHC) to evaluate an approach to increase guideline-recommended testing among patients at high-risk for developing CKD.
Through electronic health record (EHR) data analysis, eligible patients were identified to receive an at-home, semi-quantitative urine albumin-creatine ratio (uACR) testing kit. The kits provided immediate results via a smartphone application, as well as automatically routed to the clinic EHR for the patient's provider to coordinate necessary follow-up care. This initiative was conducted in Missouri, USA in 2023 and evaluated using domains of the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework.
Results reflect that 1496 of 4677 (32%) eligible patients completed uACR testing with 50% receiving abnormal results indicative of albuminuria. Of those with evidence of albuminuria, 84% had follow-up visits and 32% completed appropriate follow-up testing based on clinical guidelines. Albuminuria was prevalent across all age groups, with 69% of abnormal results appearing in patients under 60 years. Consistent with national data, patients identifying as Black were significantly more likely to have albuminuria in this cohort ( < .0001). Notably, most patients with albuminuria had an eGFR ≥60 mL/min/1.73 m.
Findings highlight the urgency of improving uACR testing for early CKD diagnosis, especially in safety-net settings. The findings also demonstrate the utility of at-home testing to improve access to care across underserved communities and represent a replicable, efficient model to identify those with high risk of CKD progression. While the program required significant time and coordination, this can be streamlined for analogous programs. Future opportunities exist to further the impacts including additional quality improvement activities to ensure follow-up testing and close gaps in CKD care.
慢性肾脏病（CKD）影响着美国七分之一的成年人，但其中90%的患者仍未意识到自己的病情，且只有不到20%的高危个体接受了适当检测。安全网医疗保健机构承受着不成比例的CKD负担，其患者群体中CKD风险因素、社会剥夺以及诊断检测障碍更为常见，这些因素会延迟诊断和挽救生命干预措施的获取。美国国家肾脏基金会与一家联邦合格健康中心（FQHC）合作，评估一种增加CKD高危患者中指南推荐检测的方法。
通过电子健康记录（EHR）数据分析，确定符合条件的患者可获得家用半定量尿白蛋白 - 肌酐比值（uACR）检测试剂盒。这些试剂盒通过智能手机应用程序提供即时结果，并自动传输至诊所的EHR，以便患者的医疗服务提供者协调必要的后续护理。该倡议于2023年在美国密苏里州开展，并使用覆盖范围、有效性、采用率、实施情况和维持情况（RE - AIM）框架进行评估。
结果显示，4677名符合条件的患者中有1496名（32%）完成了uACR检测，其中50%的检测结果异常，表明存在蛋白尿。在有蛋白尿证据的患者中，84%进行了随访，32%根据临床指南完成了适当的后续检测。蛋白尿在所有年龄组中都很普遍，69%的异常结果出现在60岁以下的患者中。与国家数据一致，在该队列中，认定为黑人的患者出现蛋白尿的可能性显著更高（<0.0001）。值得注意的是，大多数有蛋白尿的患者估算肾小球滤过率（eGFR）≥60 mL/min/1.73m²。
研究结果凸显了改进uACR检测以早期诊断CKD的紧迫性，尤其是在安全网环境中。研究结果还证明了家用检测对于改善服务不足社区的医疗服务可及性的效用，并代表了一种可复制、高效的模型，用于识别CKD进展高危人群。虽然该项目需要大量时间和协调，但类似项目可以简化流程。未来有机会进一步扩大影响，包括开展更多质量改进活动，以确保后续检测并缩小CKD护理差距。
