Guideline Concordance of Chronic Kidney Disease Testing Remains Low in Patients with Diabetes and Hypertension: Real-World Evidence from a City in Northwest China.

Introduction: This study aimed to evaluate the guideline concordance of chronic kidney disease (CKD) testing among high-risk patients in a city in Northwest China and identify key factors influencing testing practices. Methods: A retrospective cohort study was conducted using electronic health records data across Weinan city. The study included 202,847 adult patients diagnosed with diabetes and/or hypertension, excluding those with known CKD at baseline. Considering albuminuria test is not available in Weinan city, guideline-concordant CKD testing in this study was defined as conducting annual tests for both estimated glomerular filtration rate (eGFR) and proteinuria throughout the follow-up period, with the endpoint being the incidence of CKD or mortality. A Cox regression model was used to identify key factors influencing CKD testing practices. Results: The study population had 19.3% diagnosed with diabetes only, 71.8% with hypertension only, and 8.9% with both conditions. Throughout the follow-up period, only 0.70% of participants underwent annual tests for both eGFR and proteinuria as recommended by guidelines, while 3.44% had at least one test for both eGFR and proteinuria. Better adherence to CKD testing guidelines was associated with presence of diabetes, male gender, younger age, higher educational attainment, nonsmoking status, urban healthcare insurance, residence in urban areas, and engagement in light physical work. Conclusion: Routine CKD testing in Northwest Chinese with diabetes and hypertension remains uncommon, despite guideline recommendations. Given that diabetes and hypertension are leading causes of CKD in China, these findings emphasize the urgent need for strategies to improve kidney health management among high-risk populations.