Evidence map›Paper›PMID 36434513›Full record

ArticleBMC primary care2022

Albuminuria testing and nephrology care among insured US adults with chronic kidney disease: a missed opportunity.

Chi D Chu, Neil R Powe, Michael G Shlipak, Rebecca Scherzer, Sri Lekha Tummalapalli, Michelle M Estrella, Delphine S Tuot

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC primary care, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
19citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

19 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Article
  4. Care Processes and Clinical Responses to Newly Detected Albuminuria: The Stockholm Creatinine Measurements (SCREAM) Project.American journal of kidney diseases : the official journal of the National Kidney Foundation · 2026
    Article
  5. Article
  6. Chronic kidney disease management in primary care: challenges and possible developments.The British journal of general practice : the journal of the Royal College of General Practitioners · 2025
    Article
  7. Article
  8. Observational
  9. Observational
  10. Article
  11. Article
  12. Article
  13. Article
  14. Review
  15. Article
  16. Epidemiology of Diabetic Kidney Disease among US Veterans.Diabetes, metabolic syndrome and obesity : targets and therapy · 2024
    Article
  17. Article
  18. Article
  19. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Chi D ChuDepartment of Medicine, University of California, San Francisco, CA, USA. Chi.Chu@ucsf.edu.ORCID 0000-0002-6069-1507
Neil R PoweDepartment of Medicine, University of California, San Francisco, CA, USA.
Michael G ShlipakDepartment of Medicine, University of California, San Francisco, CA, USA.
Rebecca ScherzerKidney Health Research Collaborative, Department of Medicine, University of California, San Francisco, CA and San Francisco VA Health Care System, San Francisco, CA, USA.
Sri Lekha TummalapalliKidney Health Research Collaborative, Department of Medicine, University of California, San Francisco, CA and San Francisco VA Health Care System, San Francisco, CA, USA.
Michelle M EstrellaDepartment of Medicine, University of California, San Francisco, CA, USA.
Delphine S TuotDepartment of Medicine, University of California, San Francisco, CA, USA.

Funding

Evaluating the Impact of Guidelines on Physician Prescription Practices in Chronic Kidney DiseaseF32DK122629 · NIDDK · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI CHU, CHI · 2019 to 2020
$157k
NIDDK NIH HHS F32 DK122629
6 · The paper itself

Abstract

backgroundIn chronic kidney disease (CKD), assessment of both estimated glomerular filtration rate (eGFR) and albuminuria are necessary for stratifying risk and determining the need for nephrology referral. The Kidney Disease: Improving Global Outcomes clinical practice guidelines for CKD recommend nephrology referral for eGFR < 30 ml/min/1.73m

methodsUsing a national claims database of US patients covered by commercial insurance or Medicare Advantage, we identified patients with CKD who were actively followed in primary care. We examined receipt of nephrology care within 1 year among these patients according to their stage of CKD, classified using eGFR and albuminuria categories. Multivariable logistic regression was used to examine odds of receiving nephrology care by CKD category, adjusting for age, sex, race/ethnicity, diabetes, heart failure, and coronary artery disease.

resultsAmong 291,155 patients with CKD, 55% who met guideline-recommended referral criteria had seen a nephrologist. Receipt of guideline-recommended nephrology care was higher among those with eGFR < 30 (64%; 11,330/17738) compared with UACR ≥300 mg/g (51%; 8789/17290). 59% did not have albuminuria testing. Those patients without albuminuria testing had substantially lower adjusted odds of recommended nephrology care (aOR 0.47 [0.43, 0.52] for eGFR < 30 ml/min/1.73m

conclusionsOnly half of patients meeting laboratory criteria for nephrology referral were seen by a nephrologist. Underutilization of albuminuria testing may be a barrier to identifying primary care patients at elevated kidney failure risk who may warrant nephrology referral.

Indexed as

NephrologyRenal Insufficiency, ChronicAdultAgedAlbuminuriaGlomerular Filtration RateHumansMedicareUnited StatesAlbuminuriaChronic kidney diseaseNephrology referral

Identifiers

PMID36434513
PMCPMC9700954

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.