MO370: Perceptions of Barriers and Mitigating Strategies for Suboptimal Albuminuria Testing: A Global Survey of a Range of Specialists
Authors: Garreta Rufas Antonio , Meredith Kimberley , Harris James 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Regular estimated glomerular filtration rate (eGFR) and albuminuria testing in patients diagnosed with chronic kidney disease (CKD) and those with specific risk factors such as type 2 diabetes is recommended in The Kidney Disease Improving Global Outcomes (KDIGO) guidelines. An eGFR test can indicate kidney function decline, whereas albuminuria testing estimates kidney damage. Therefore, when used in combination an accurate understanding of CKD risk progression can be obtained. In addition, the European Society of Cardiology updated its guidelines in 2021 to recommend albuminuria testing for cardiovascular risk assessment in CKD patients, demonstrating growing awareness of the link between kidney damage and CV events. Evidence from real-world practice suggests albuminuria testing, specifically urine albumin-to-creatine ratio (UACR) testing is suboptimal. For example, UACR testing, is not regularly undertaken in clinical practice, with low rates of testing reported in the UK1 (67%), The Netherlands2 (57%), and France3 (29%). Until now, there have been limited data available that identifies perceptions—from both a global and multi-specialist perspective—around why UACR testing is so low, and what drives this non-adherence in type 2 diabetes patients.

METHOD
This global questionnaire was administered as an online survey to a range of cardiologists, endocrinologist or diabetologists, nephrologists and primary care physicians attending a kidney disease expert meeting organized by Bayer.

RESULTS
Of the 112 individuals who received the survey link, 56 responded to the questionnaire, consisting of 11 (20%) cardiologists, 17 (31%) endocrinologists or diabetologists, 24 (44%) nephrologists and 2 (4%) primary care physicians across 25 countries in Asia, Europe, North America, South America and Oceania.
When asked the main reason for a lack of UACR testing in type 2 diabetes patients, 27% (n = 15) suggested it was due to lack of physician awareness of guidelines/the test (Asia [n = 3, 20%]; Europe [n = 7, 47%]; North America [n = 2, 13%]; South America [n = 2, 13%]; Oceania [n = 1, 7%]), 16% (n = 9) suggested that doctors forget to order a test, and 11% implied that doctors and/or patients find UACR testing an inconvenience.
Following a UACR test, the majority of respondents (n = 35, 70%) believed that test results are not optimally incorporated into clinical practice (Asia [n = 8, 23%]; Europe [n = 20, 57%]; North America [n = 1, 3%]; South America [n = 4, 11%]; Oceania [n = 2, 6%]). Twenty-two respondents suggested opportunities to improve adherence incorporation of UACR test results, of whom 20 (87%) raised a need for increased awareness and education. Fifteen (30%) respondents believed that UACR test results are optimally incorporated into clinical practice, 7 of these were from physicians practicing in Asia.

CONCLUSION
This survey demonstrates that UACR tests are not being consistently and globally undertaken and integrated into clinical practice, with a lack of guideline and test awareness being a prominent contributor toward this. Physicians across a wide range of specialties and geographies suggested that there is a need for increased education to help target suboptimal testing rates.
Funding: Bayer AG