A study led by U of A medical researcher Aminu Bello found that less than 20 per cent of Canadian patients with Chronic Kidney Disease are receiving a critical test within six months of diagnosis. The test is used to assess the severity of the kidney disease and the risk of developing adverse health outcomes such as end-stage kidney failure, heart disease and strokes.
Millions of Canadians living with Chronic Kidney Disease (CKD) may be going without critical urine testing from their primary care practitioners.
A team of researchers across Canada, the United States and the UK examined the records of more than 46,000 Canadian patients with CKD who were cared for through primary care practices. It found that less than 20 per cent of patients received a urine albumin test within six months of diagnosis-an important test used to detect the severity of kidney disease and risk for development of adverse health outcomes such as end stage kidney failure (requiring dialysis or transplant), heart disease and strokes.
"It's a problem," said Aminu Bello, an associate professor of medicine at the University of Alberta and lead author of the study. "It's not that primary care physicians are negligent, because they are doing well in many other areas. But this is an area we need to focus on because it's critical."
It's unclear why urine albumin testing was not routinely conducted by primary care practitioners in the study. Albumin in the urine is an indication of damage in the kidney. The greater the level found, the higher the chance that people will lose kidney function over time. It also amplifies the risk of cardiovascular diseases such as heart attacks and strokes.
It's estimated that 10 to 12 per cent of Canadians are living with chronic kidney disease, with more than 90 per cent of those patients being cared for by primary care practitioners.
According to Bello, primary care practitioners did meet most other key benchmarks for managing chronic kidney disease in their patients. For example, the study found that more than 75 per cent of the time primary care physicians achieved the recommended targets when it came to checking blood pressure of patients, ensuring patients were at the proper target for blood pressure control and in giving them appropriate medication when required.
Bello hopes that by addressing the gap in care, more Canadians can avoid end-stage kidney disease, benefitting both their own lives and Canada's health-care system.
According to most recent estimates by the Canadian Organ Replacement Registry, about 39,000 Canadians are living with end-stage kidney failure, and are on dialysis or have had a transplant. It costs about $100,000 a year per person to provide dialysis. The costs of providing care to people living with end-stage kidney failure consumes about two to three per cent of the total health-care budget in most high-income countries like Canada.
"We want to ensure that Canadians with mild or moderate kidney disease get really high-quality care early on, so we can prevent them ending up on dialysis or getting to the stage where they require a kidney transplant to live," said Bello.
According to Bello, the urine albumin test is covered under Canada's health-care system and is easy to do without requiring any sophisticated equipment. He believes the low adherence to conducting the test may be due to a lack of awareness of current guidelines or a lack of time with patients due to heavy workload.
A number of initiatives are underway across the country to address the gaps and enhance quality care for patients with CKD. Locally, Alberta Health Services Kidney Health Strategic Clinical Network has made it a key priority in order to reduce the risk of adverse health outcomes associated with CKD.
"We are very fortunate to be supported by these initiatives to impact kidney care positively in our communities," said Bello."So it's a matter of engagement and making primary care more aware that this test is equally important as checking blood pressure,It's an opportunity to have a dialogue about it because we can do better."
Funding for the study Quality of Chronic Kidney Disease Management in Canadian Primary Care was provided by the Canadian Institutes of Health Research, and published by JAMA Network Open.