Health data from millions of people, including UK Biobank participants, reveal that effective tests to spot kidney disease remain underused.
Summary
Simple blood and urine tests can help GPs to better spot people who are at risk of kidney failure – and offer treatments that slow the disease’s progression. But data from more than 2 million people, including UK Biobank participants, have shown that only 25% of people with chronic kidney disease regularly do these tests. The team behind the research is calling for more awareness of the tests’ benefits among clinicians and patients.
Simple blood and urine tests can help GPs to better spot people who are at risk of kidney failure. But many doctors and their patients remain unaware of the tests’ benefits, according to health data from more than 2 million people, including UK Biobank participants.
Our research shows that at present, not enough people with kidney disease have their urine tested, and therefore may be missing out on the best treatments.
Dr Jennifer Lees, University of Glasgow, UK
“Our research shows that at present, not enough people with kidney disease have their urine tested, and therefore may be missing out on the best treatments,” study team member Jennifer Lees from the University of Glasgow, UK, said in a statement.
Chronic kidney disease (CKD) is extremely common: in the UK, it affects around 7.2 million people. People with early-stage CKD often are unaware that they have the conditions because they don’t have any symptoms. Only a very small percentage of people will eventually need dialysis or a kidney transplant. If GPs spot those cases early enough, kidney specialists can often help people to slow down the disease’s progression.
In 2021, the guidance for how GPs should judge someone’s future risk of kidney failure was overhauled. Instead of solely testing the kidneys’ blood-filtering ability (estimated glomerular filtration rate, eGFR), the new guidelines also take into account someone’s sex and age and suggest an ‘albuminuria’ test once a year. This urine test checks for the albumin, a biomolecule that is not present in urine if the kidney is healthy.
Analysis of health data from more than 466,000 UK Biobank participants plus 1.8 million people in a public database showed that the new guidelines are effective at pinpointing who should be referred to a specialist. In particular, the new testing regime is better at flagging low kidney function in people from Black and minority ethnic groups, who are at greatest risk of kidney failure because of a complex mixture of economic, social and structural factors.
Regular testing is needed
The study aimed to provide GPs with reassurance that the guidance “hadn’t changed in a way that was going to mean a massive influx of patients [into specialist care] or indeed a massive underdiagnosis”, explains Lees’ Glasgow colleague and study team member Paul Welsh.
But only 25% of people with CKD get checked for albuminuria regularly, even though it is cheap and easy to do. One of the reasons could be that clinicians rely on the eGFR value alone – if it seems normal, they might not consider an additional test. Another issue is that people with early-stage CKD also often feel well enough and might not appreciate how their condition could progress, so they don’t follow up.
More patients with kidney disease need to have access to this new tool.
Dr Michael Sullivan, University of Glasgow, UK
Without regular testing of both eGFR and albuminuria, people could be missing out on the specialist support they need. “More patients with kidney disease need to have access to this new tool,” study leader Michael Sullivan, also at Glasgow, said in a statement. “Our research shows that for this to be possible, more patients need to bring urine samples to their GP.”