An estimated 37 million, or 1 in 7 adults, in the United States have Chronic Kidney Disease (CKD). Unfortunately, 90% don’t know they have the condition until it’s too late to prevent its serious and expensive consequences. It doesn’t have to be like this.

In an impressive display of collaboration and an unprecedented timeframe for change in health care, the National Kidney Foundation (NKF), National Committee for Quality Assurance, and other national organizations have aligned their levers to build important groundwork to improve the diagnosis and prognosis for people with or at risk of chronic kidney disease. NKF is now turning to physicians, health plans, employers, and patients to pick up the cause. Read on to learn about the diagnosis and treatment of kidney disease, connect with resources, and understand how you can take actions to protect your workforce and the people important to you from chronic kidney disease. 

The kidneys are vital to life. They remove excess toxins from the blood, balance key electrolytes and fluid volume, and excrete hormones that help regulate blood pressure, red blood cell production, activate vitamin D, and support bone strength. The primary cause of kidney disease is diabetes, followed by hypertension. CKD increases the risks of heart disease, stroke, and early death, in addition to kidney failure. Many people with CKD die of a heart attack because of the strain that kidney failure places on their heart. 

Practice guidelines now recommend two screenings, a blood and a urine test, annually to assess for kidney disease among people with diabetes, hypertension, or other risk factors for CKD. The blood test is the estimated glomerular filtration rate (eGFR) and it assesses kidney function. The urine Albumin-to-Creatinine Ratio (uACR) assesses kidney damage. Both are needed. In 2020, major laboratories collaborated to create a standardized kidney profile that bundles the eGFR and uARC into one request, which more easily enables clinicians to order and compare results across labs. 

It’s not a urine dipstick. Convenient and commonly used in the physician office to check for protein in the urine, dipstick urine tests do not detect lower albumin and creatinine levels and are not recommended for assessing kidney damage. Often the earliest sign of CKD, an elevated uACR (≥30 mg/day) can detect kidney damage about 10 years before a decline in eGFR is observed, so at-risk patients should get an uACR. 

To improve treatment outcomes, race is no longer included in the eGFR equation. African Americans and Hispanics are disproportionately affected by CKD and are more likely to progress to kidney failure than Whites. However, it has been recognized that race is a social and not biological construct, including race when assessing screening results could unintentionally worsen disparities in care. This led to a taskforce recommendation that the adjustment for race be removed. African American and Hispanic patients may find changes in their kidney disease status or stage when they are first tested by a lab which has completed this transition.  

A single quality measure now includes both tests. The Kidney Health Evaluation for Patients with Diabetes was developed by the National Kidney Foundation and the National Committee for Quality Assurance (NCQA) for implementation in 2021, and public reporting of results is expected in 2022. The Centers for Medicare & Medicaid Services has also begun to transition a similar measure into its Merit-based Incentive Payment Systems (MIPS) programs. Due to recent debate around the numerical definition of hypertension, NCQA was unable to include people with hypertension in the measure denominator at this time. Screening rates in people with hypertension need further attention.

Screening rates are way too low. The average testing rate for people with diabetes is less than 50% nationally, which leaves an enormous number of people in the dark about their disease. Kidney screening rates in Missouri lag the nation. With support from Bayer, the Midwest Health Initiative (MHI) was able to apply the new NCQA measure to statewide data, learning that in 2021 only 40.9% of commercially insured adult Missourians with a diagnosis of diabetes received these two kidney tests. Congratulations to Esse Health for a top screening rate of 67.8% in the St. Louis region.

The US Preventive Services Task Force announced last month that due to new evidence and treatments that support assessing asymptomatic patients, it would re-evaluate adding screening for chronic kidney disease (CKD) to its list of preventive services.  

Employers have an important role to play in advancing screening. Early diagnosis and treatment can meaningfully reduce suffering, save lives, and lower spending. Ask your health plan to provide a baseline screening rate for your at-risk population. Align your health education and wellness strategies with those of your vendors to increase screening rates. Talk with your physician, friends, and family about kidney screening. These changes have occurred recently and rapidly. Not all providers are aware of them, so it’s important for patients at risk to request the tests. 

Education and resources from the CDC, NKF, and a toolkit from NCQA and Bayer are also available. The BHC stands ready to support your efforts. Please reach out with any questions or requests.

Warm Regards,

Louise Y. Probst,

BHC Executive Director