Testing to Fight Kidney Disease
Two years ago, the American Society for Clinical Pathology (ASCP) was presented with an opportunity to ratchet up adherence to one of its 30 recommendations — #21, which deals with evaluating adult patients with diabetes or hypertension for chronic kidney disease (CKD) through commonly used laboratory tests.
“What Choosing Wisely did was speed up the trajectory more than start the initiative,” said Lee Hilborne, MD, MPH, Past President and Chair of ASCP’s Appropriate Test Utilization Committee and Senior Medical Director for Quest Diagnostics, referring to the society’s partnership with the National Kidney Foundation to harmonize and simplify the testing protocol used to detect CKD.
The two organizations, in a first-of-its-kind collaboration, introduced a new Kidney Profile, that recommends pairing two tests for CKD assessment under one heading on the lab requisition form or electronic health record order and encouraging annual testing for high-risk groups – such as patients with diabetes, hypertension or both.
“It’s really nothing more than taking existing tests and packaging them in a way that makes it easy for clinicians to order those tests, allowing them to do the right thing easily,” said Hilborne. Additionally, streamlining the test order increases the ease of monitoring results to track a patient’s health. “The good news is that these are simple tests and they are not expensive. Importantly, performing both CKD tests increases the value of care by encouraging testing practices that seek to maximize the diagnostic benefit to patients.”
Hilborne said recently that all major diagnostic testing labs in the United States now offer the Kidney Profile consistent with the society’s Choosing Wisely recommendations. The intent is that this new option will help identify at-risk patients earlier to prevent CKD and/or slow its progression.
According to the CDC, 37 million American adults are estimated to be living with kidney diseases, but many are unaware of their status. When diagnosed, many patients are in the later stages of CKD or experiencing kidney failure, which requires dialysis or a kidney transplant.
Joseph Vassalotti, MD, Chief Medical Officer for the National Kidney Foundation, said the Kidney Profile is critical to its chronic kidney disease intercept program as it promotes timely, effective and efficient laboratory diagnostics that identify problems early and monitor disease progression.
Vassalotti said that even though the two risk factors for CKD are diabetes and hypertension, as many as 94 percent of patients with high blood pressure go untested for the urine albumin-creatinine ratio. Sixty-one percent of diabetics and 60 percent of patients with both of medical conditions do not annually receive the pair of tests that assess kidney function and kidney damage, as recommended by clinical practice guidelines.
“We are indebted to the labs and to ASCP. We really couldn’t have done this without the labs,” said Vassalotti, noting that educating primary care clinicians and patients about the importance of this testing combination is critical to early diagnosis and improved health outcomes. Through the collaboration, the organizations provide information to health care professionals and patients.
About 100,000 Americans start dialysis each year, and over 500,000 patients receive dialysis annually, according to Vassalotti. Already, there has been a significant uptake in diagnostic labs performing the Kidney Profile nationwide.
“Even if we can’t prevent progression, kidney failure or complications, at least more people will be aware that they have kidney disease and have the opportunity to take medications regularly or change their lifestyles – instead of crashing into dialysis,” he said.