Closing the diagnosis gap in chronic kidney disease

Chronic kidney disease (CKD) is a costly, complex blind spot for many Americans. More than half (58%) aren’t familiar with the disease at all,¹ though it affects more than 1 in 7 U.S. adults.² Heightened risk doesn’t always translate to greater awareness, either.

People over age 60 were even less familiar than younger respondents, though age is a clear risk factor for developing CKD.³ And though diabetes is one of the main risk factors for developing the condition, less than 40% of people with diabetes get the recommended kidney health screenings.⁴

Missed screenings fuel the alarming reality that 9 in 10 people with CKD are unaware that they have the condition.⁵ While an early diagnosis may help slow the disease’s progression, the diagnosis often comes only once it’s far more acute — and treatments far more costly.

The impact of a timely CKD diagnosis is so profound, in fact, that it’s being considered as a recommended routine screening.⁶ One study suggests that screening everyone age 35 and older for CKD would be a cost-effective way to increase life expectancy.⁷

Improving early diagnosis may seem daunting. The following strategies can help payers create real impact.

Primary care providers (PCPs) are often the front line for kidney screenings. This makes equipping them with the knowledge and tools for timely diagnosis essential.

Consider, for instance, that 62% of PCPs use estimated glomerular filtration rate (eGFR) tests to assess kidney function in patients with type 2 diabetes.⁸

Far fewer (30%) PCPs use urine albumin-creatinine ratio (uACR) tests.⁹ Yet guidelines call for the uACR to be performed at least annually for all patients with type 2 diabetes, regardless of treatment.¹⁰

Suboptimal as 30% may seem, when researchers examined the health records of more than half a million patients receiving primary care across at more than 1,100 clinical practice sites, they found dramatic variation.

At the extremes, some primary care settings achieved 75% testing rate for uACR, while others hit a mere 13%.¹¹

Health plans can play a powerful role in identifying outliers and rolling out targeted provider communications to promote appropriate guideline-based testing. 

That collaboration should be well received, as public reporting for the Healthcare Effectiveness Data and Information Set now includes a measure called the Kidney Health Evaluation for Patients with Diabetes (KED).

Developed by the National Kidney Foundation and National Committee for Quality Assurance, the measure assesses whether patients with diabetes receive an annual kidney evaluation, including both the eGFR and uACR tests.¹²

Starting in 2024, Medicare Advantage plans will report against the KED measure as part of the STAR ratings systems.¹³

Another example of impactful provider education? The American Heart Association (AHA) recently rolled out a new provider-facing risk calculator (called PREVENT) that combines measures of cardiovascular, kidney and metabolic health to estimate the 10- and 30-year risk of cardiovascular disease.¹⁴

The newest such AHA tool in a decade, the calculator turns a brighter spotlight on kidney health. It can help providers initiate conversations with their patients about the overlapping nature of CKD and cardiovascular disease — as well as encourage them to get screened.

Because CKD is either asymptomatic or symptomatic in ways that are often mistaken for other ailments, patients may be regularly engaging with their PCP and not know to raise the question of kidney health.

On the provider side, managing the many comorbidities often associated with CKD may mean that recommended kidney screenings fall off the radar. But data analytics can help point to a potential CKD diagnosis, even when patients and providers are focused elsewhere.

Payers are increasingly applying data analytics to lab results, procedure codes, revenue codes and diagnosis codes to surface clusters of kidney-related symptoms that should prompt providers to test a member’s renal function.

For instance, if a member with high blood pressure and diabetes sees a dermatologist for persistent puffiness around the eyes (a lesser-known symptom of CKD), that visit alone might not raise any flags.

But an algorithm-based trigger could alert administrators to ensure the member gets the CKD screening they need.

At the provider level, data analytics can help risk-stratify patient populations, visualize trends around diagnosis and even illuminate insights around particular comorbidities or patient cohorts.

Pharmaceutical ads use all manner of tactics to talk directly to consumers, including on the topic of kidney health. And though health plans are no stranger to member outreach, the increasing convergence of payers and providers means directly engaging members around their health is becoming the norm.

When that engagement extends to kidney care — and helping members better understand the risks, prevalence, comorbidities and common symptoms of CKD — all sides win.

Health plans are now making a concerted effort to more directly educate their members, particularly those at greater risk, about this disease.

March is National Kidney Month¹⁵ — a natural opportunity to reach out to members about the disease they may not even realize they have, in particular those who have been diagnosed with diabetes or high blood pressure.

The American Society of Nephrology #SockItToKidneyDisease event is on March 9. Participants are asked to wear their most bold and colorful socks to help raise awareness of the disease.¹⁶

But kidney health shouldn’t be a topic of engagement only one month each year. To truly move the needle on diagnosis rates, CKD awareness should be a constant drumbeat in health plans’ marketing materials, website, newsletters and mailers.

While the clinical invisibility of early CKD makes it a highly difficult condition to diagnose before it reaches an advanced stage, there are solutions. Casting a far wider net of testing would not only catch cases of CKD far earlier but would also reduce overall loss of life and payer spend on kidney conditions.

The solutions are right in front of us — it’s just a matter of implementing them.