INDUSTRY INSIGHTS [ ] data + trends + context
Diabetes is the leading cause of chronic kidney disease (CKD) and accounts for 36% of new cases of kidney failure. Among patients with type 2 diabetes, about one-third also have CKD, which may be already present when diabetes is first diagnosed. 1 To screen, diagnose, and
stage CKD, the American Diabetes Association recommends
measuring urinary albumin (urinary albumin-to-creatinine
ratio, and estimated glomerular filtration rate (eGFR)) at least
once a year in all patients with type 2 diabetes. 2
In prior analyses, AMGA analytics found that in a population of 3.8 million patients eligible for screening for diabetes
(per ADA Standards of Care for Diabetes3), only 56% were
screened. 4 Further, among 61,000 patients with a positive
screening test indicative of diabetes, only 35% had a diagnosis or prescription for an anti-diabetes medication within
three months. 5 As a follow-up to this study, we focused on
screening for CKD, which is recommended annually once
patients are diagnosed with type 2 diabetes.
Study Population: 765,000 patients age 18–75, with a
diagnosis on a claim or problem list for type 2 diabetes,
and an ambulatory visit in the last 12 months (01/01/2018–
12/31/2018). Data were abstracted from electronic
health records (EHRs) from 21 different AMGA member
Methods: Patients were considered screened for CKD if
they had both a urine albumin-to-creatinine ratio and eGFR
measured and documented in a structured field in the EHR.
Both measurements were required to be within 365 days prior
to the patient’s most recent office visit (evaluation and management) or 30 days after.
F Overall, 42% of patients with type 2 diabetes were screened
for CKD (urine albumin-to-creatinine ratio and eGFR measured, blue in Figure 1).
F Across individual healthcare organizations, screening rates
ranged from 25 to 53%.
F Across individual sites of care (i.e., clinic practices) within
healthcare organizations, screening rates ranged from 1%
F All organizations have high- and low-performing sites of care.
Where Are We Now?
Screening for chronic kidney disease among patients with type 2 diabetes
Screening Rates for Chronic Kidney Disease
at Six Healthcare Organizations
1 14 4 2 2 5 5 3 36 6
Individual Healthcare Organizations Individual Sites of Care (n=383)
UACR or e GFR missing
UACR or e GFR measured
765,000 patients age 18–75 with type 2 diabetes, and > 1 visit in 2018 across 21 healthcare organizations. For the sample of six healthcare organizations, patient populations range from
16,000 to 150,000 patients. Patients are attributed to sites of care that provided the plurality of care in a two year period; sites of care with fewer than 100 patients attributed were excluded
from the analysis. Abbreviations: eGFR, estimated glomerular filtration rate; UACR, urine albumin to creatinine ratio.