Impact of Albumin-to-Creatinine Ratio Point-of-Care Testing on the Diagnosis and Management of Diabetic Kidney Disease

Abstract

Background: For the diagnosis of diabetic kidney disease (DKD), quantitative albuminuria measurement using the albumin-to-creatinine ratio (ACR) is recommended according to various guidelines. It can be measured either in specialized laboratories or using ACR point-of-care testing (POCT). This observational study aims at evaluating the effect of ACR POCT utilization on the DKD diagnosis and treatment management for glycemic control and blood pressure. Method: Data of 717 patients with diabetes (type 1 diabetes: n = 236; type 2 diabetes: n = 463; other diabetes forms: n = 18) were assessed in three centers. The impact of ACR POCT on DKD diagnosis and treatment management for glycemic control and blood pressure was assessed using a case report form. The assessment of ACR POCT utilization purpose and relevance for physicians was documented using a questionnaire. Results: Of all participants (n = 717), 39.1% had a confirmed/suspected DKD diagnosis. Hereof, 8.6% were newly diagnosed with DKD, and 9.9% were suspected with DKD based on the actual ACR POCT values. Within the group of patients with confirmed/suspected DKD (n = 280), treatment modification was performed in 46.1% of participants. A drug initiation with GLP-1 receptor agonists or SGLT2 inhibitors was performed in 11.1% or 8.9% of patients with confirmed/suspected DKD, respectively. Regarding the utilization purposes of ACR POCT, 100% of the physicians (n = 8) indicated using it to examine patients with diabetes with or without hypertension; 75% considered it very important for patients with diabetes. Conclusions: The implementation of ACR POCT may positively affect DKD diagnosis and subsequently allow better management of patients with diabetes.

CVOT Summit Report 2023: new cardiovascular, kidney, and metabolic outcomes

“…Nevertheless, a survey of primary care professionals in Europe [ 76 ] found that only 32.4% were fully confident in interpreting UACR results. Currently, UACR can also be determined by point-of-care testing (POCT) [ 77 ]. The survey also revealed that there is an unmet need for more information on screening, detection, and management of CKD [ 76 ].…”

Practical Strategies for Diagnosis and Treatment of CKD

“…A change of medication based on the UACR POCT was performed in 21.6% of individuals with T2D and mostly in those with a severely increased UACR of >30 mg/ mmol. The majority of physicians involved in the study regarded UACR POCT as very important for people with diabetes (75%) and important for individuals without diabetes (75%) [53]. Thus, POCT tools should be made available in primary care to improve diagnostic rates and quality of care.…”