Very few patients with abnormal urine protein dipstick results have recommended follow-up testing for early kidney disease

Very few patients with abnormal urine protein dipstick results have recommended follow-up testing for early kidney disease

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-00549 

URL goes live when the embargo lifts       

A study of more than 1 million health records found that very few patients with abnormal urine protein dipstick results had follow-up testing for early kidney disease by albuminuria testing as recommended by clinical guidelines. The follow-up albuminuria testing rate was higher, although still low, among people with diabetes, likely due to annual albumin–creatinine ratio (ACR) testing recommendations by the American Diabetes Association. These findings are important because detecting albuminuria level with ACR testing can identify patients at elevated risk for heart and kidney disease and could determine whether treatment is needed. The brief research report is published in Annals of Internal Medicine.

Albuminuria is when a protein called albumin is found in urine at higher-than-normal levels, which can indicate kidney damage. Detecting albumin is important because if confirmed, it signifies kidney disease and increased risk for heart disease, stroke, and death. Researchers from Geisinger Health (Danville, Pennsylvania), Johns Hopkins University (Baltimore, MD), and New York University (New York City, NY) used anonymous electronic health record data from a large database to identify adults who had a doctor’s visit in 2021 that included a blood test to check kidney function and a urine dipstick to test for the presence of protein. People who had a known condition that may cause protein in their urine were excluded from the study. Of 1,042,740 people tested across 33 U.S. health systems, 13% had abnormal protein levels. Within one year, only 6.7% of those with abnormal results had further testing for albuminuria, compared to 4% of those with normal results. Follow-up testing rates were slightly higher but still low for those with more abnormal protein levels. Of those who had follow-up tests, 43.3% had confirmed albuminuria, with higher protein levels on the initial test linked to a higher chance of confirmation. According to the study authors, these findings show a crucial opportunity to better identify patients with kidney disease through follow-up ACR testing after abnormal protein dipstick results, allowing patients to reduce their heart and kidney risk with appropriate therapies.

Media contacts: For an embargoed PDF, please contact Angela Collom at [email protected]. To speak with corresponding author Alexander R. Chang, MD, MS, please e-mail [email protected].