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The President’s Invited Session at the 2020 AACC Annual Scientific Meeting & Clinical Lab Expo brings together a patient, a clinician, and a laboratorian to discuss testing strategies for fighting chronic kidney disease (CKD) in integrated healthcare settings. Clinical laboratory professionals, like many individuals, are unaware of the seriousness that surrounds CKD, AACC President David G. Grenache, PhD, D(ABCC), FADLM, chief scientific officer of TriCore Reference Laboratories, told CLN Stat.
The National Kidney Foundation (NKF) has created a laboratory engagement plan to raise awareness about two important laboratory tests that could help integrate testing for CKD into routine clinical care, said Grenache. These are the estimated glomerular filtration rate (eGFR) and the urine albumin-to-creatinine ratio (ACR). Most clinical labs already perform these tests but don’t utilize them to their full potential. NKF is advocating that labs create a “kidney profile” test that would report the results of these two critical tests in one test order, said Grenache.
“While this seems like an easy initiative to operationalize, there are barriers that labs have to consider and address if they are to do so. This session seeks to call attention to this need and its challenges,” he said.
Fighting CKD Together: The Patient, Clinician, and Laboratorian Perspective (34115) takes place December 16 from 11 a.m.–12:30 p.m. Central Standard Time and is worth 1.5 ACCENT credit hours. Alexis Conell, a CKD patient, starts off the panel by discussing her own personal journey with kidney disease. “Early diagnosis of CKD is so incredibly important in the management of the disease and will allow time for implementation of early preventive measures. Early implementation may be able to delay and in some cases prevent further progression of the disease,” Conell told CLN Stat.
Joseph Vassalotti, MD, chief medical officer of the National Kidney Foundation, and Greg Miller, PhD, DABCC, professor of pathology at Virginia Commonwealth University, will discuss improvement opportunities for the kidney profile from the clinical and laboratorian’s point of view, respectively.
Approximately 37 million U.S. adults have CKD, but only 10% are aware of their condition, said Vassalotti. Patients often don’t have symptoms of their disease until it’s advanced.
Additionally, the average level of care patients receive in both primary and nephrology specialty care is suboptimal, he noted. “For Americans like Alexis living with kidney diseases, we must work to prevent or at least delay kidney failure development as proposed by the Advancing American Kidney Health Initiative,” he said. “We can also reduce complications of kidney disease that limit the quality or the duration of life, including hospitalization and cardiovascular events.”
ACR in high-risk patients is underutilized, said Vassalotti. Combining the eGFR with the ACR would accurately detect and risk stratify kidney disease, leading to interventions such as risk factor control of diabetes and hypertension, as well as the use of kidney and heart-protective medications, said Vassalotti.
The Kidney Profile order makes it easier for physicians to order these two tests, noted Miller. Labs should work with their information system colleagues to introduce the Kidney Profile into the order sets physicians use to care for patients with increased CKD risk. Labs should also collaborate with nephrologist colleagues to encourage ordering of the Kidney Profile. “Although the tests in the Kidney Profile have Current Procedural Terminology (CPT) codes for billing, the profile itself does not,” Miller continued. The laboratory community should support a CPT code assignment for the Kidney Profile to make billing easier.
Patients can also work with their interdisciplinary care team to coordinate care to confront CKD challenges and incorporate healthy lifestyles, said Vassalotti. “Clinical laboratories can help, under the leadership of professionals like Drs. Miller and Grenache, to ensure accurate testing and reporting as well as engage in quality improvement and population health for CKD,” he noted.
Patients deserve to have access to testing, to know that their kidneys are functioning properly, stressed Conell. “These tests should be standard and/or scheduled the same as mammograms or colonoscopy. They are just that important and can save lives.”