ANN ARBOR, MI — A new study that included VA researchers made the case for much more dual testing for chronic kidney disease (CKD) in high-risk patients to improve disease management and patient outcomes.
The review led by researchers from the University of Michigan and the VA Ann Arbor MI, Healthcare System pointed out that simultaneous urine testing for albumin (UAlb) and serum creatinine (SCr), called “dual testing,” is a quality measure used to help manage diabetes.
“As chronic kidney disease (CKD) is defined by both UAlb and SCr testing, this approach could be more widely adopted in kidney care,” they wrote in BMJ Open.1
For the study, which was performed in conjunction with national Centers for Disease Control and Prevention (CDC) researchers, the study team assessed time trends and facility-level variations in the use of outpatient dual testing within the VHA system.
Included in the retrospective cohort study were patients with any inpatient or outpatient visit to the VHA system from 2009-2018. For purposes of the study, dual testing was defined as UAlb and SCr testing in the outpatient setting within a calendar year.
The researchers focused on issues of demographics, comorbidities, high-risk (e.g., diabetes) specialty care and facilities over time.The study analyzed data from about 6.9 million veterans per year.
Results indicated that dual testing increased, on average, from 17.4% to 21.2% but varied substantially among VHA centers (0.3%-43.7% in 2018).
“Dual testing was strongly associated with diabetes (OR 10.4, 95% CI 10.3 to 10.5, p<0.0001) and not associated with VHA center complexity level,” the authors advised. “However, among patients with high-risk conditions including diabetes, <50% received dual testing in any given year. As compared with white veterans, Black veterans were less likely to be tested after adjusting for other individual and facility characteristics (OR 0.93, 95% CI 0.92 to 0.93, p<0.0001).”
The study concluded that dual testing for CKD in high-risk specialties is increasing but remains low, suggesting, “This appears primarily due to low rates of testing for albuminuria. Promoting dual testing in high-risk patients will help to improve disease management and patient outcomes.”
- Bhave NM, Han Y, Steffick D, Bragg-Gresham J, et. al. Assessing trends and variability in outpatient dual testing for chronic kidney disease with urine albumin and serum creatinine, 2009-2018: a retrospective cohort study in the Veterans Health Administration System. BMJ Open. 2024 Feb 12;14(2):e073136. doi: 10.1136/bmjopen-2023-073136. PMID: 38346884; PMCID: PMC10862291.