Abstract: PUB111
CKD Monitoring in Routine Clinical Practice: An Analysis of a National Laboratory Database
Session Information
Category: CKD (Non-Dialysis)
- 1901 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Ennis, Jennifer L., Laboratory Corporation of America Holdings, Chicago, Illinois, United States
- Luo, Dajie, Laboratory Corporation of America® Holdings, Durham, North Carolina, United States
- Gillespie, Barbara S., Covance CRO; University of North Carolina, Cary, North Carolina, United States
Background
Published guidelines for chronic kidney disease (CKD) have existed for many years, but guideline implementation remains inconsistent in clinical practice. We evaluated the frequency of guideline-based CKD monitoring for patients with laboratory evidence of CKD in a data set from a national laboratory.
Methods
We identified all patients who had at least 2 eGFR results below 60 ml/min/1.73m2 at least 3 months apart based on serum creatinine testing performed at a LabCorp facility between November 2011 and April 2018. We then analyzed whether certain guideline-recommended tests (urine albumin/creatinine ratio (UACR), serum phosphorus (P), plasma parathyroid hormone (PTH), and LDL cholesterol (LDL-C)) were performed a) within 1 year of or b) at any time after the first qualifying eGFR result.
Results
Among the 4,909,840 patients who met criteria for the study, 58.2% were women. Mean age was 71.2 ± 12.0 years. Median follow-up was 25.7 (IQR=12.2 – 45.8) months. The percentage of patients in stage 3a, 3b, 4, and 5 based on the initial eGFR result were 70.3%, 21.9%, 6.3%, and 1.5%, respectively. At 1 year, rates of testing for UACR, PTH, and P were 24.4%, 11.8%, and 16.9%, respectively. Any time testing rates were only slightly higher: 35.4% (UACR), 20.5% (PTH), and 25.3% (P). However, rates of LDL-C testing at 1 year (75.5%) and any time (84.4%) were much higher, indicating that other routine testing was being performed on these patients.
Conclusion
Despite guideline recommendations, routine laboratory testing for CKD and its comorbidities remains low in US clinical practices. This data highlights the need for further strategies to improve CKD evaluation and management.