Diagnostic Yield of Various Serum Creatinine Testing Frequencies in People At Risk for CKD.

Background: Guidelines recommend regular serum creatinine testing to detect chronic kidney disease (CKD) among people with diabetes or hypertension, but the ideal frequency of testing is unknown. We determined the diagnostic yield for incident CKD as defined by ≥2 measures of eGFR <60 mL/min/1.73m2, based on testing frequencies of every 2, 3, 4 or 5 years as compared to annually.

Methods: We did a retrospective population-based cohort study of 3,515,163 adults aged >18 years with eGFR >60 mL/min/1.73m2 at baseline in Alberta, Canada. We assessed diagnostic yield overall, and in categories defined by age, sex, comorbidity, albuminuria, or levels of a multivariable risk score for CKD.

Results: Assuming annual testing, the number of tests needed (NTN) to detect one new CKD case was >67-fold higher among those aged <50 years (2149, [95%CI 2103,2196]) as compared to >70 years (32, [32,32]). NTN for annual testing were 50 (49,50) among people with diabetes, 57 (57, 58) in those with hypertension and 20 (20,21) among people with heart failure. When stratified by CKD risk score, the NTN for annual testing ranged from 7 (7,8) at a score of 9 (highest risk), to 5708 (5494,5930) at a score of 0 (lowest risk). Testing people with diabetes every three years instead of every year would delay the diagnosis of CKD by a mean of 1.5 years for 2, 12, and 32 per 1000 people with diabetes aged <50, 50-70 and >70 years respectively. Corresponding delays associated with testing people with hypertension every three years instead of every year would impact 2, 9, and 27 per 1000 people aged <50, 50-70 and >70 years respectively. If applied to all adult Albertans, these two changes in testing frequency would potentially avert more than 5.9 million laboratory assays over the next decade.

Conclusions: Tailoring the frequency of serum creatinine testing according to age and the presence of other risk factors would decrease the number of tests needed to detect cases of incident CKD.