Closing Gaps in Chronic Kidney Disease Detection: Evaluating At-Home Targeted Testing in a Safety-Net Population

Area of Science:

• Nephrology
• Public Health
• Health Services Research

Background:

• Chronic Kidney Disease (CKD) affects 1 in 7 US adults, with 90% unaware and <20% of at-risk individuals tested.
• Safety-net settings disproportionately serve CKD patients with risk factors and barriers to care.
• The National Kidney Foundation partnered with an FQHC to boost CKD testing in high-risk populations.

Purpose of the Study:

• To evaluate an at-home urine albumin-creatine ratio (uACR) testing approach.
• To increase guideline-recommended CKD testing in a safety-net setting.
• To identify individuals at high risk for CKD progression.

Main Methods:

• Electronic health record (EHR) analysis identified eligible patients for at-home uACR testing kits.
• Kits provided immediate results via smartphone app and routed data to clinic EHRs.
• The initiative was evaluated using the RE-AIM framework in Missouri, USA (2023).

Main Results:

• 32% of eligible patients (1496/4677) completed uACR testing; 50% showed albuminuria.
• 84% with albuminuria had follow-up visits, 32% completed guideline-recommended follow-up testing.
• Albuminuria was prevalent across age groups, particularly in Black patients (P<.0001), often with eGFR ≥60 mL/min/1.73 m².

Conclusions:

• Urgent improvement in uACR testing is needed for early CKD diagnosis, especially in safety-net settings.
• At-home testing improves access to care in underserved communities, offering a replicable model for CKD risk identification.
• Streamlining program coordination and implementing quality improvement activities can further enhance follow-up testing and close CKD care gaps.