<p><i>Objective:</i>
An estimated 37 million Americans have chronic kidney disease (CKD). Nearly 90%
do not know about their condition because of low awareness about the importance
of CKD testing and diagnosis among practitioners and people at-risk for CKD.
This study utilizes data from a national clinical laboratory to identify
guideline-recommended CKD testing rates across the United States.</p>
<p><i>Research
Design and Methods:</i> Patients with Laboratory Corporation of
America® Holdings (Labcorp®) testing between 2013 and 2019 were defined as
at-risk for CKD if they had any testing ordered with diagnosis codes for
diabetes and/or hypertension. Guideline-concordant CKD assessment was defined
by estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (uACR) testing within the
study year.</p>
<p><i>Results:</i>
We identified 28,295,982 at-risk patients (mean age 60.6 ± 14.8 y, 53.6% women): 16.2% had
diabetes, 63.8% had hypertension and 20.1% had both comorbidities. Of these,
80.3% did not receive guideline-concordant assessment during the study period.
Furthermore, only 21.0% had uACR testing versus 89.6% with eGFR. CKD
assessment occurred at least once in 28.7% of patients with diabetes, 10.5% of
hypertensive, and 41.4% of those with both. In a state-by-state comparison,
annual testing rates ranged from 5% - 30%. The nationwide rate increased
modestly each year between 2013 and 2018 (10.7% to 15.2%).</p>
<p><i>Conclusions:</i>
Despite guideline recommendations, testing for CKD with uACR and eGFR in U.S.
adults with diabetes and hypertension is low in routine clinical care. These
data highlight the need for strategies to improve routine CKD assessment
nationwide.</p>