Abstract 4368752: Chronic kidney disease testing in patients with hypertension

Abstract

Introduction: All hypertensive patients should have chronic kidney disease (CKD) testing with estimated glomerular filtration rate (eGFR) and urine albumin to creatinine ratio (ACR) according to KDIGO guidelines. However, rates of testing for CKD, especially with ACR remain low. Research Question: What is the prevalence of testing for CKD in older adult patients with hypertension in two large health systems. Methods: We present data from patients from two health systems which participated in an NIH-funded, pragmatic, hybrid implementation effectiveness study assessing a virtual collaborative care clinic (vCCC) in large health systems. Patients ≥65 years of age with a systolic blood pressure of >160 mm Hg or two consecutive systolic blood pressure readings of >140 mm Hg were included. Testing for CKD and other baseline characteristics were obtained through the PCORnet common data model. Measures of CKD testing included eGFR, ACR, and urine protein to creatinine ratio (PCR) in the 2 years prior to enrollment. Categorial variables were reported as frequencies and percentage and continuous variables were reported as mean and standard deviation. Results: A total of 1000 patients were enrolled in the study, with mean age of 73.3 ± 5.6 years, 51.3% females, 87.7% white. Of the 1000 patients, only 3.2% had no CKD testing; but 75.8% of patients only had eGFR testing and only 20.9% of patients had both eGFR and urinary testing with ACR or PCR. One patient had only ACR without eGFR. Those with both diabetes and hypertension (28.8% of the enrolled participants), had higher proportion of patients (53.1%) with CKD testing with both eGFR and ACR or PCR. Black race, and Hispanic ethnicity also had a higher proportion of CKD testing with both eGFR and ACR or PCR compared to the whole group. Table 1 describes detailed demographics and baseline characteristics associated with CKD testing. Conclusions: The prevalence of CKD testing in older patients with hypertension – who have a higher risk of CKD, remains low in the real world despite published guidelines. CKD testing is better in certain groups such as those with both hypertension and diabetes. These data demonstrate a large gap in guidelines and clinical practice and identify areas of opportunities for early detection of CKD.