Concordance With Screening and Treatment Guidelines for Chronic Kidney Disease in Type 2 Diabetes
Authors' conclusion
In this cohort study of patients with T2D, fewer than one-quarter received recommended CKD screening. In patients with CKD and albuminuria, 21.0% did not receive an SGLT2 inhibitor or an ACEI or an ARB, despite compelling indications. Patient-level factors may inform implementation strategies to improve CKD screening and treatment in people with T2D.
Study context
- Population
- Adults with T2D at 20 US health care systems (PCORnet): without known chronic kidney disease (CKD), outpatient visit 2015–2020 (screening); with CKD (eGFR 30–90 mL/min/1.73 m², UACR 200–5000 mg/g), visit Oct 2019–Dec 2020 (treatment)screening cohort
- Participants
- 316,234 adults
- Outcome
- Concordance with CKD screening (creatinine and UACR measured) and treatment (ACEI or ARB and SGLT2 inhibitor prescription)
- Follow-up
- Screening within 15 months of index visit; treatment within 12 months before or 6 months after
Methodological detailsmulticentre (20 health care systems), Data analyzed July 8, 2022, through June 22, 2023
- Multicentre (20 health care systems)
- Data analyzed July 8, 2022, through June 22, 2023
Main finding
As reported in the abstract
- Received creatinine and UACR screening
- 24.9%
- Received 1 screening measurement
- 56.5%
- Received neither screening
- 18.6%
- CKD with albuminuria (n=4215): received ACEI or ARB
- 3288 (78.0%)
- CKD with albuminuria: received SGLT2i
- 194 (4.6%)
- CKD with albuminuria: received neither therapy
- 885 (21.0%)
Observational data: associations, not effects.
Further findings
Risk factors for nonconcordance with screening
- Hispanic ethnicity associated with lack of screening, RR
- 1.16 (95% CI 1.14-1.18)
- HF, peripheral arterial disease and hypertension associated with lower risk of nonconcordance
Risk factors for lack of CKD treatment
- Peripheral arterial disease and lower eGFR associated with lack of treatment; diuretic or statin prescription and hypertension associated with treatment
Original publication
Concordance With Screening and Treatment Guidelines for Chronic Kidney Disease in Type 2 Diabetes. JAMA Netw Open. Published 3 June 2024. doi:10.
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