Advancing CKD and Cardiovascular Risk Management Through Diagnostic Testing - Episode 8
uACR and eGFR Testing in CKD: Addressing Barriers and Patient Communication
Why uACR urine testing lags: incentives, workflow gaps, and silos—and how KDIGO staging strengthens kidney and cardiovascular risk conversations.
In this episode, ‘uACR and eGFR Testing in CKD: Addressing Barriers and Patient Communication,’ the panelists explore the following questions:
- What clinical or workflow-related barriers limit uACR testing, and how can these barriers be addressed in practice?
- What are the barriers with eGFR testing?
- How do you communicate CKD biomarker results to patients in a way that conveys cardiovascular risk without causing alarm or disengagement?
The discussion explores the multifaceted barriers to routine CKD testing, highlighting how historical reliance on urine dipsticks and fragmented "siloed" care models prevent clinicians from adopting uACR as a standard of care. Dr. Beavers and Dr. Desai note that simple operational fixes—such as building automated reminders into EHR panels and updating value-based care incentives—are essential to moving beyond current screening gaps. The experts specifically challenge the "finger-pointing" between specialties, urging the cardiovascular community to own kidney screening much like they eventually took ownership of lipid management.
Furthermore, the panel discusses the clinical utility of the KDIGO heat map not just for staging kidney disease, but as a visual aid to communicate additive cardiovascular risk to patients. By reframing uACR as a marker of endothelial dysfunction and vascular damage, clinicians can better engage patients who are already oriented toward heart health. This segment concludes with a call to align practice with modern risk-prediction tools like the AHA PREVENT equations, which officially integrate renal markers into holistic cardiovascular risk assessments.
The next episode in this series, ‘Unmet Needs Remaining in CKD Diagnosis,’ features the panelists advancing their conversation on chronic kidney disease and focusing on critical unmet needs in CKD care, highlighting that despite established guidelines, less than 25% of eligible patients currently receive appropriate screening. They advocate for a radical redesign of care delivery—ranging from expanding screening into pharmacies to utilizing "cardiovascular-renal-metabolic" (CRM) specialty clinics—to ensure that preventive, guideline-directed medical therapy is implemented before patients reach end-stage disease.
