A UK-wide survey, conducted by Napp Pharmaceuticals, suggests that over half of GPs and nurses treating patients with type 2 diabetes do not carry out a vital kidney test.
The Urine Albumin-to-Creatinine Ratio (UACR) test is used to detect protein in the urine, signalling kidney damage which can lead to fatal complications, and according to survey respondents, the UACR test, which is recommended by UK guidelines for diabetes management, is not being administered annually. Over half (54%) of GPs and nurses who treat patients with type 2 diabetes do not carry out the vital routine test annually.
The urine test, which identifies early markers of kidney damage, is not routinely carried out by GPs and nurses in annual reviews, mainly because many patients are reluctant to provide a urine sample.
Why are these tests not being carried out?
The UACR test is recommended by UK guidelines for diabetes management and, according to the study, is not being administered annually to all patients as it should be because many patients (38%) are unwilling to provide a urine sample (which is the most frequent reason given by healthcare professionals).
Diagnosis, prevention and slowing the rate of decline in kidney disease is critical to the successful management of the known co-morbidities in type 2 diabetes . It is also an important factor in reducing the strain on services used to type 2 diabetes. Diabetes is estimated to cost the NHS £14bn per year, and over 80% of those costs are the result of managing complications of the disease, including those associated with the kidney and the heart. Routine kidney function testing is an important way of identifying those people who are at risk of disease progression.
Dr Kevin Fernando, GP with Specialist Interests in Diabetes & Medical Education, North Berwick Health Centre said: “The kidneys are often overlooked in favour of the heart in the treatment of type 2 diabetes. However, if you protect the kidneys, you can help protect the heart. Any sign of accelerated kidney damage, no matter how early, multiplies the risk of death.
“By making a small change to clinical practice to routinely measure kidney function and motivate patients to provide samples, doctors and nurses have an opportunity to spot damage early and positively intervene in those patients who are identified as being at risk.”
Awareness and action
As mentioned, according to the healthcare professionals surveyed, the most frequent reason given for not conducting the UACR test is that patients are unwilling to provide a urine sample.
Dr Aisling McMahon, Executive Director for Research, Innovation & Policy at Kidney Research UK said: “These survey results are sadly unsurprising, indeed they bear out findings from our own research among people with diabetes. Large numbers of people within this patient group are unaware that they are at increased risk of developing kidney problems, and how life-limiting those kidney problems can become. Having a simple urine test can help diagnose kidney problems early, and treatment and adjustments to lifestyle can make an enormous difference.”
Awareness and action on kidney damage are a partnership between the healthcare professional and patients. According to the study:
- Despite 79% of healthcare professional’s surveyed admitting that they knew the UACR test should be used as best practice;
- 75% underestimated the impact of kidney disease on cardiovascular mortality; and
- Once they were told the level of risk, 85% responded that their colleagues would be more likely to conduct kidney function testing if they were aware of the true increase in risk of death.
The importance of being open to testing
A spokesperson from the National Kidney Federation said: “Effective diabetes management means more than just blood sugar control. So many patients and doctors are unaware that kidney damage is occurring and just how serious it can be for someone with diabetes. If patients knew the true impact of kidney disease, they may be more willing to provide a urine sample to help prevent further decline.
“We call on patients to learn about their health and for doctors and nurses to take the time to explain that by giving a urine sample we can identify any kidney disease, to monitor its progression and predict future health.”
The survey, commissioned by Napp Pharmaceuticals, was conducted online via the physician network, SERMO during October and November 2019. Only UK Practice nurses and GPs who confirmed they were actively involved in the management of patients with type 2 diabetes were able to participate.
To learn more about the likelihood of being at risk of developing kidney problems, read more here: https://kidneyresearchuk.org/kidneyhealthcheck/