Chronic Kidney Disease and Improving Diagnoses: ARUP Teams Up to Identify Patients at Risk

A man receiving peritoneal dialysis
February 27, 2018

Thirty million people have chronic kidney disease (CKD), but only 3.6 million know they’ve got the disease. With few early symptoms, people may not realize they have the disease until their kidney function is significantly depleted. That can be fatal without dialysis or a kidney transplant.

One in three American adults is at risk for chronic kidney disease as a result of hypertension or diabetes. CKD progression can be slowed or halted if the disease, which often has no symptoms, is caught in its early stages.

To identify and treat patients sooner, this month a one-of-a-kind collaboration was formed to remove barriers to testing for CKD. Collaborators include: the National Kidney Foundation (NKF), the American Society for Clinical Pathology (ASCP), clinical laboratory societies, and the nation's leading laboratories—including ARUP.

Diagnosing kidney disease early is critical to improving long-term health in patients; this was the impetus for uniting the laboratory community around solving this problem. The new 'Kidney Profile' makes it easier for primary care physicians to determine if an at-risk patient has kidney disease, as it contains all the critical tests in one easy-to-order place.

Joseph Vassalotti, MD, Chief Medical Officer, National Kidney Foundation.

The goal is to help standardize the tests used to detect CKD, improve comparison of test results between laboratories, increase early recognition of the disease, and promote patient awareness of the condition.  

“The National Kidney Foundation initiative aims to make it easier to use the widely available laboratory tests that are shown to best identify patients at risk for chronic kidney disease,” says Joely Straseski, PhD, an ARUP medical director who specializes in endocrinology.

“Ironically, the relatively common laboratory tests used in this area can be quite confusing in their naming and reporting. The National Kidney Foundation hopes to make testing for kidney function straightforward and consistent, thereby helping at-risk populations get diagnosed earlier,” adds Straseski, who is also an associate professor of pathology at the University of Utah School of Medicine. They will do this by focusing on standardizing terminology and reporting units, which are needed for consistent result interpretation.

New Test Profile for Chronic Kidney Disease

A component of this new collaboration is the recommendation of a new test profile for CKD assessment and diagnosis. This new CKD "Kidney Profile" follows evidence-based clinical practice guidelines,which recommend two tests for CKD assessment. Laboratories adopting the "Kidney Profile" will simplify ordering of the tests needed to detect and diagnose CKD by pairing them under one heading on the laboratory requisition form or electronic health record order. Such streamlining of CKD test ordering could help to eliminate the need to search for each test separately, and increases the ease of monitoring results. The "Kidney Profile" also makes it easier for people at risk for CKD to better understand and track their health.

"Diagnosing kidney disease early is critical to improving long-term health in patients; this was the impetus for uniting the laboratory community around solving this problem," said Joseph Vassalotti, MD, Chief Medical Officer, National Kidney Foundation. "The new 'Kidney Profile' makes it easier for primary care physicians to determine if an at-risk patient has kidney disease, as it contains all the critical tests in one easy-to-order place."

Currently, 94 percent of patients with high blood pressure (hypertension) and 61 percent with diabetes are not receiving both tests necessary to detect and assess chronic kidney disease as recommended by clinical practice guidelines, despite these being the top two risk factors for developing chronic kidney disease.

Screening for CKD in the primary care setting may help more patients be diagnosed in early stage disease and ultimately improve outcomes.

Lab Details: Chronic “Kidney Profile”

The new Kidney Profile combines the estimated glomerular filtration rate (eGFR), which assesses kidney function, and urine albumin-creatinine ratio (ACR), which assesses kidney damage. Both are used to test for and diagnose CKD in primary care settings.  Specifically, the Kidney Profile combines 1) eGFR and 2) urine ACR. People living with CKD have an elevated risk for cardiovascular disease. This combination of eGFR and ACR testing has been shown to be a strong predictor of both cardiovascular mortality and kidney failure risk.

NKF and ASCP also recommend that laboratories use the same equation to estimate GFR, and rename the microalbumin test to one that more accurately reflects what it is measuring: albumin-creatinine ratio, urine.  Standardized ACR reporting using milligrams per gram will make it easier for clinicians to compare results received from different labs.

Healthcare professionals can learn more about the Kidney Profile by visiting www.ascp.org/kidneyprofile. A fact sheet for doctors to share with their patients is available.  This brochure explains what kidneys do, how to keep kidneys healthy and what tests determine if kidneys are working properly.

Other Laboratories Can Join

The collaboration is believed to be the first to combine the resources and talents of leading clinical laboratory societies, multiple laboratory providers, and a patient advocacy group to advance improvements in CKD laboratory testing.

“It is unique for so many laboratories to be engaged simultaneously, and that highlights the importance and relevance of this national campaign,” says Straseski. Besides ARUP Laboratories, BioReference Laboratories, Inc., LabCorp, Mayo Medical Laboratories, Memorial Sloan Kettering Cancer Center, Quest Diagnostics, and Sonic Healthcare USA have aligned with the initiative recommendations to improve CKD screening, diagnosis and care management. Any interested laboratory can join the collaboration and execute the suggested changes.

This article extracted information from a National Kidney Foundation press release (Feb. 21, 2018). For more information, contact the foundation.

Peta Owens-Liston, ARUP Science Communications Writer

 

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