title: Primary care detection of chronic kidney disease in adults with type-2 diabetes: the ADD-CKD Study (awareness, detection and drug therapy in type 2 diabetes and chronic kidney disease).
abstract: This US, multicenter, observational study assessed the CKD prevalence in adult patients with type-2 diabetes mellitus (T2DM) and characterized the proportion of detected and undiagnosed CKD in the primary care setting using the following: a clinician survey; a patient physical exam and medical history; a single blood draw for estimated glomerular filtration rate (eGFR) and glycosolated hemoglobin (HbA1c); urine dipstick for protein; urine albumin-creatinine ratio (ACR); two patient quality of life questionnaires; and a 15-month medical record review. The study consisted of 9339 adults with T2DM and 466 investigator sites. Of the 9339 enrolled, 9307 had complete data collection for analysis. The 15-month retrospective review showed urine protein, urine ACR, and eGFR testing were not performed in 51.4%, 52.9% and 15.2% of individuals, respectively. Of the 9307 patients, 5036 (54.1%) had Stage 1-5 CKD based on eGFR and albuminuria; however, only 607 (12.1%) of those patients were identified as having CKD by their clinicians. Clinicians were more successful in diagnosing patients with Stage 3-5 CKD than Stages 1 and 2. There were no differences in clinicians' likelihood of identification of CKD based on practice setting, number of years in practice, or self-reported patients seen per week. Awareness or patient self-reported CKD was 81.1% with practitioner detection versus 2.6% in the absence of diagnosis. Primary care of T2DM demonstrates recommended urine CKD testing is underutilized, and CKD is significantly under-diagnosed. This is the first study to show CKD detection is associated with awareness.
authors.affiliation: Durham Nephrology Associates, Durham, North Carolina, United States of America.
authors.forename: Lynda A
authors.initials: LA
authors.lastname: Szczech
authors.affiliation: Scientific Activities Department, The National Kidney Foundation, Inc., New York, New York, United States of America.
authors.forename: Rebecca C
authors.initials: RC
authors.lastname: Stewart
authors.affiliation: Covance Inc., Princeton, New Jersey, United States of America.
authors.forename: Hsu-Lin
authors.initials: HL
authors.lastname: Su
authors.affiliation: Covance Inc., Princeton, New Jersey, United States of America.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: DeLoskey
authors.affiliation: Departments of Medicine and Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America.
authors.forename: Brad C
authors.initials: BC
authors.lastname: Astor
authors.affiliation: Department of Family Medicine, University at Buffalo, Buffalo, New York, United States of America.
authors.forename: Chester H
authors.initials: CH
authors.lastname: Fox
authors.affiliation: Baylor Health Care System, Baylor Heart and Vascular Institute, Dallas, Texas, United States of America.
authors.forename: Peter A
authors.initials: PA
authors.lastname: McCullough
authors.affiliation: Scientific Activities Department, The National Kidney Foundation, Inc., New York, New York, United States of America; Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Vassalotti
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000652:urine*; D001364:Awareness; D003404:Creatinine / Q000652:urine*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000652:urine*; D005260:Female; D005919:Glomerular Filtration Rate; D006442:Glycated Hemoglobin / Q000378:metabolism; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011788:Quality of Life; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000652:urine*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
chemical_list: D003404:Creatinine; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human