Variations in Kidney Function Testing in Patients with CKD and Type 2 Diabetes

NKF 2021 Spring Clinical Meetings

There are wide variations in the prevalence of type 2 diabetes and chronic kidney disease (CKD) across geographic regions. However, despite the importance of the diagnosis and management of CKD among patients with type 2 diabetes, there are few data evaluating the geographic variations in estimated glomerular filtration rate (eGFR) and urine albumin creatinine ratio (UACR) testing in that patient population.

During a virtual poster session at the NKF Spring Clinical Meetings 2021, Xue Feng, PhD, and colleagues reported on an analysis of state-by-state variations in testing of kidney function in patients with type 2 diabetes. The poster was titled Geographic Variations in Kidney Function Testing among Patients with Type 2 Diabetes.

The researchers utilized Optum Clinformatics® claims data from 2015-2019 to identify adult patients with type 2 diabetes and patients with both type 2 diabetes and CKD. Tests of eGFR and UACR were examined by state for the two populations separately. The proportions of tested patients were summarized during the 1-year period following diagnosis of type 2 diabetes and CKD. The proportions of patients receiving adequate monitoring (defined according to Kidney Disease Improving Global Outcomes clinical guidelines) were reported in patients with type 2 diabetes and CKD.

Of the 632,105 patients with type 2 diabetes, the rate of eGFR testing was 86.0%, and the rate for UACR testing was 33.6%. There were wide variations in the testing rates across states, ranging from 68.5% in Wyoming to 93.9% in Alabama for eGFR and from 12.3% in Wyoming to 56.6% in Hawaii for UACR.

Among the patients with both type 2 diabetes and CKD (n=101,057), the testing rates were higher. The rate for eGFR testing in that patient population was 94.1%; the rate for UACR testing was 38.7%. There were cross-state variations in testing rates among patients with both type 2 diabetes and CKD, ranging from 79.5% in Colorado to 97.3% in Alabama for eGFR and from 14.0% (Maine) to 58.9% (Hawaii) for UACR.

Percentages of patients receiving adequate monitoring ranged from 64.4% in Colorado to 91.9% in Georgia for eGFR and from 7.1% in Minnesota to 30.9% in Florida for UACR.

In conclusion, the authors said, “This study showed that large geographic variations exist in kidney function testing across states. A particular concern is under testing for UACR. The association between kidney function testing and CKD-related outcomes warrants further evaluation.”

Source: Feng X, Betts KA, Song J, et al. Geographic variations in kidney function testing among patients with type 2 diabetes (T2D). Abstract of a poster presented at the National Kidney Foundation 2021 Spring Clinical Meetings (Abstract #206), April 9, 2021.