Chronic kidney disease diagnosis rates remain flat despite more screening, according to a new analysis from the National Kidney Foundation and Manatt Health. The report finds that while testing for the condition has increased among Medicare beneficiaries, the improvements have not translated into more patients being identified in the early stages of the disease. This disconnect highlights a gap between the availability of diagnostic tools and their practical application in clinical settings.
Screening Rates Rise, but Early Detection Lags
Between 2016 and 2023, the percentage of Traditional Medicare enrollees receiving both an estimated glomerular filtration rate (eGFR) blood test and a urine albumin-to-creatinine ratio (uACR) urine test increased from 17% to 20%. For Medicare Advantage enrollees, the rate climbed from 24% to 28% during the same period. Despite this uptick, the researchers found no meaningful increase in the percentage of patients receiving a CKD diagnosis at stage G1 or G2. The data suggests that more people are being screened, but those screenings are failing to catch the disease early enough to change outcomes.
Both tests are necessary for a full evaluation. An eGFR measures how well the kidneys filter blood, while a uACR detects albumin in the urine, which can indicate kidney damage. “Both of those tests are important for not only detection of whether a person has kidney disease or not, but also how severe the kidney disease is,” Joseph Vassalotti, MD, chief medical officer of the National Kidney Foundation, told MedCentral. “I think that the key issue is that the [uACR] is fundamental and the [uACR] is often missing.”
The uACR Gap
The analysis reveals that eGFR testing is significantly more common than uACR testing among Medicare enrollees. In most years, approximately 80% or higher of beneficiaries received an eGFR test, while fewer than 20% received the recommended combination of both tests. Michal Melamed, MD, director of NYU Langone’s Chronic Kidney Disease Center, noted that the disparity is counterintuitive given that both tests are relatively simple to perform.
“Testing serum creatinine to estimate a GFR and urine microalbumin is easy to do, and most patients appreciate knowing about their kidney disease early,” Melamed said. “The ironic thing is that the serum testing is much more common compared to the urine testing. I find that patients usually are not resistant to giving urine.” The reliance on blood tests alone limits the ability to stratify risk and identify patients who might benefit from earlier intervention.
Staging Improves, but Awareness Lags
While the absolute number of early-stage diagnoses has not risen, there has been a decline in unspecified staging. From 2017 to 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 those in Medicare Advantage. This shift toward precise staging allows clinicians to make more informed decisions about referrals and follow-up care.
Early detection is critical because new medications can slow the progression of the disease. “Early detection is important in CKD because there are so many new medications that are proven to slow the progression of CKD,” Melamed said. “If detected early, it’s now possible that medications can delay or prevent patients from requiring dialysis in the future.” The inability to diagnose patients earlier means that many are only learning about their condition after it has advanced, at which point treatment options become more limited.
Systemic Barriers and Recommendations
Medicare Advantage enrollees consistently had higher rates of full kidney health evaluations than those in Traditional Medicare. The analysis attributes this disparity to differences in care management, coding practices, and financial incentives. The authors recommend further research to assess testing rates among high-risk populations, such as those with diabetes or hypertension, and to study the time lag between initial testing and a documented diagnosis.
Without a diagnosis, there is a lack of awareness regarding kidney health, which prevents patient engagement and the implementation of protective lifestyle modifications. Additionally, the analysis notes that specific data are needed to understand how payment incentives influence testing behaviors and outcomes. The researchers emphasize that improving the uptake of uACR testing is essential to fully realize the benefits of early-stage identification.