<b>Objective:
</b>Clinical guidelines for people with diabetes recommend
chronic kidney disease (CKD) testing at least annually using estimated
glomerular filtration rate (eGFR) and urinary albumin-creatinine ratio (uACR). We
aimed to understand CKD
testing among people with type 2 diabetes in the United States.
<p><b>Research
Design and Methods:</b> Electronic health record data were
analyzed from 513,165 adults with
type 2 diabetes, receiving primary care from 24
health care organizations and 1,164 clinical practice sites. We assessed the percentage of patients with both ≥1
eGFR and
≥1 uACR,
<a></a><a>and
each test</a> individually, in the 1, 2, and 3 years ending September 2019,
by health care organization and clinical practice site. Elevated albuminuria
was defined by uACR ≥30 mg/g.</p>
<p><strong>Results:</strong> The 1-year median testing rate across organizations was 51.6% for both
uACR and eGFR, 89.5% for eGFR, and 52.9% for uACR. uACR testing varied (10<sup>th</sup>–90<sup>th</sup>
percentile) from 44.7% to 63.3% across organizations and from 13.3% to 75.4%
across sites. Over 3 years, the median testing rate for uACR across
organizations was 73.7%. Overall, the prevalence of detected elevated
albuminuria was 15%. The average prevalence of detected
elevated albuminuria increased linearly with uACR testing rates at sites, with
estimated prevalence of 6%, 15%, and 30%, at uACR testing rates of 20%, 50%,
and 100%. </p>
<p><strong>Conclusions:</strong> While eGFR testing
rates are uniformly high among people with type 2 diabetes, testing rates for uACR
are suboptimal and highly variable across and within the organizations examined.
Guideline-recommended uACR testing should increase detection of CKD.</p>
Chronic kidney disease and cardiovascular risk in hypertensive type 2 diabetics: a primary care perspective
