Despite increased screening for chronic kidney disease (CKD) among Medicare enrollees from 2016 to 2023, early diagnosis rates have remained largely unchanged. A recent analysis by the National Kidney Foundation (NKF) and Manatt Health reveals that while more patients are being tested, the percentage diagnosed at early stages (G1 or G2) has not significantly improved.
CKD evaluation requires both estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (uACR) tests. However, the analysis found that uACR testing remains underutilized, with fewer than 20% of adults in the U.S. receiving both recommended tests.
Testing Rates Rise, But Early Diagnoses Lag
Between 2016 and 2023, the percentage of Traditional Medicare enrollees receiving both eGFR and uACR tests increased from 17% to 20%. For Medicare Advantage enrollees, this rate rose from 24% to 28%. Despite this, the study found no meaningful increase in early-stage CKD diagnoses.
“Both tests are essential for detecting CKD and assessing its severity,” said Joseph Vassalotti, MD, chief medical officer of the National Kidney Foundation. “The uACR test, in particular, is often missing, which is a key issue.”
Disparities in Testing and Staging
Medicare Advantage enrollees consistently had higher rates of full kidney health evaluations compared to Traditional Medicare enrollees. The authors suggest this disparity may stem from differences in care management, coding practices, and financial incentives.
Staging Precision Improves Despite Flat Early Diagnosis Rates
While early diagnosis rates remain flat, there has been an improvement in CKD staging precision. Between 2017 and 2023, the percentage of newly diagnosed patients with an unspecified stage dropped from 42% to 33% for Traditional Medicare enrollees and from 40% to 35% for Medicare Advantage enrollees.
Precise staging is vital for patient outcomes, enabling more personalized treatment decisions, referrals, and follow-up care. Chronic kidney disease affects millions, and early detection can significantly alter its progression.
Early detection of CKD is vital as it enables interventions that can slow disease progression and potentially delay or prevent dialysis. Michal Melamed, MD, director of NYU Langone’s Chronic Kidney Disease Center, emphasized the importance of early diagnosis: “With new medications, early detection can now delay or prevent patients from requiring dialysis in the future.”
High-Risk Populations and Payment Incentives Need Further Study
The analysis highlights the need for further research to understand testing rates among high-risk populations, such as those with diabetes or hypertension. More data is required to assess the impact of payment incentives on testing and diagnosis, as well as patient outcomes based on diagnosis timing.
Without diagnosis, patients remain unaware of their condition, hindering engagement and lifestyle modifications that could protect kidney health. As Dr. Vassalotti noted, “Without diagnosis, there’s no awareness, no engagement, and no understanding of interventions to protect kidneys.”
The findings highlight ongoing challenges in CKD screening and diagnosis, despite increased testing efforts. Addressing these gaps could lead to better patient outcomes and reduced healthcare costs associated with advanced kidney disease.
Targeted Interventions to Boost uACR Testing Rates
The study by the National Kidney Foundation and Manatt Health also calls for targeted interventions to improve uACR testing rates, particularly among Traditional Medicare enrollees. Such measures could include enhanced provider education, streamlined testing protocols, and revised reimbursement policies.
Additionally, the report shows the importance of public awareness campaigns to educate high-risk individuals about the significance of early CKD detection. By supporting a proactive approach to kidney health, these initiatives could drive higher testing rates and, ultimately, better health outcomes.
The role of technology in improving CKD screening cannot be overlooked. Innovations such as electronic health record (EHR) reminders and automated risk assessment tools could help bridge existing gaps in testing and diagnosis. Implementing these solutions could ensure that more patients receive timely and accurate evaluations.
Collaborative Efforts to Overcome Systemic Barriers
Furthermore, collaboration between healthcare providers, policymakers, and patient advocacy groups is essential to address the systemic barriers to CKD screening. By working together, stakeholders can develop strategies that prioritize early detection and intervention, thereby reducing the burden of advanced kidney disease.
The financial implications of improved CKD screening are significant. Early diagnosis and treatment can prevent costly complications, such as dialysis and kidney transplantation, which place a substantial strain on healthcare systems. Investing in preventive measures now could yield long-term savings and improve quality of life for millions of patients.
Finally, the analysis emphasizes the need for ongoing monitoring and evaluation of CKD screening programs. Continuous assessment will ensure that interventions remain effective and adaptable to evolving healthcare needs. With sustained effort, the goal of reducing the impact of CKD on individuals and society remains within reach.