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TOPLINE:

Systematic home-based screening for albuminuria in primary care identified previously undiagnosed risk for chronic kidney disease (CKD), with greater participation among individuals invited by general practitioners (GPs). Overall, 8.7% of GP-invited participants had confirmed increased albuminuria, with 40.6% of them being newly diagnosed.

METHODOLOGY:

• Researchers conducted a cross-sectional screening study to evaluate the effectiveness of a systematic home-based albuminuria screening program in primary care patients at risk for CKD.
• A total of 6380 patients aged 45-80 years with risk factors for CKD were invited for home-based albuminuria screening, of whom 3802 were invited by ten GPs and 2578 were invited by five pharmacies.
• GP-invited patients were identified on the basis of the following risk factors registered in electronic medical records: Diabetes, cardiovascular disease (CVD), hypertension, lipid disorder, or obesity; pharmacy-invited patients were identified on the basis of relevant drug prescriptions.
• Home-based screening was performed using a urine collection device for the measurement of the urinary albumin-to-creatinine ratio (ACR). Participants with increased albuminuria (ACR ≥ 3 mg/mmol) underwent a confirmatory urine test and, if confirmed, were invited for elaborate screening for CKD and CVD risk factors, followed by a referral to their GP.
• The primary outcome was the participation rate and yield of the home-based albuminuria screening and the detailed screening, assessed separately for the GP group and the pharmacy group and compared between the two groups.

TAKEAWAY:

• The participation rate was significantly higher among patients invited by GPs than among those invited by pharmacies (40.1% vs 21.8%; P < .001).
• Confirmed increased albuminuria was higher among patients invited by GPs than among those invited by pharmacies (8.7% vs 6.0%; P = .046); 40.6% of GP-invited patients had previously unknown albuminuria on the basis of their electronic medical records.
• A total of 88.7% of GP-invited patients with increased albuminuria who completed the elaborate screening were identified with one or more risk factors for CKD and/or CVD, either with newly diagnosed risk factors (40.0%) or known risk factors but outside the target treatment range (65.2%).
• Follow-up data showed that 52.9% of GP-invited patients who were referred to their GP following the elaborate screening visit consulted their physician to evaluate the screening findings, leading to treatment changes in 44.4% of them.

IN PRACTICE:

"Screening in a GP setting shows benefits on top of opportunistic screening. In those patients identified with increased albuminuria, a large part had previously undiagnosed or sub-optimally controlled risk factors, suggesting that health benefits can be obtained by initiating or optimising treatment of CKD risk factors," the authors wrote.

SOURCE:

This study was led by Dominique van Mil, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. It was published online on April 08, 2025, in eClinicalMedicine.

LIMITATIONS: 

This study was unable to collect data from non-participants in the home-based screening phase due to privacy legislation, limiting the understanding of their characteristics and factors influencing their participation decisions. The ACR status of non-participants and patients in the pharmacy group was unknown. Additionally, the reliance on self-reported medical history by participants may have introduced potential bias.

DISCLOSURES:

This study was funded by AstraZeneca Netherlands. Some authors reported having stocks and ownership and receiving grants, personal fees, consultancy fees, and non-financial support from various pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.