Screening and Diagnosis of Chronic Kidney Disease in Adults Living With Diabetes: A Retrospective Cohort Study Using the Canadian Primary Care Sentinel Surveillance Network

In Canada, regional evaluations of screening practices for chronic kidney disease (CKD) among people with diabetes highlight areas for improvement; however, national estimates are notably absent. Estimates of CKD incidence often discount the expected decline in estimated glomerular filtration rate (eGFR) associated with age; age-adaptive thresholds may help account for this. We describe the frequency of screening and diagnosis of CKD among adults with diabetes from a nationally representative primary care cohort. In this retrospective cohort study, we used electronic medical record data from the Canadian Primary Care Sentinel Surveillance Network. We followed adult patients (≥18 years of age) with diabetes without CKD at baseline for 5 years starting in 2014. We determined the frequency of urine albumin-to-creatinine ratio (uACr) and/or eGFR testing over time. We identified incident CKD diagnoses based on eGFR measurements using fixed-threshold and age-adaptive definitions and quantified the incidence proportion and rate. We analyzed records from 37,604 patients with diabetes. Only 13% of patients had yearly eGFR and uACr testing for CKD, although roughly 60% had non-yearly use of both tests in 5 years. eGFR testing was performed more frequently than uACr testing (94.1% vs 76.6% having testing over follow-up). We found increased incidence proportions (14.6% vs 6.0%) and rates (33.1 vs 13.4 diagnoses per 1,000 person-years) of CKD using the fixed-threshold compared with age-adaptive definition. Our study presents the first national understanding of screening practices for CKD among people with diabetes in Canada. Specifically, increased use of uACr testing should be encouraged for early detection of changes in kidney function. Dans le contexte canadien, bien que les évaluations régionales sur le dépistage de la maladie rénale chronique (MRC) mettent en lumière des axes d'amélioration, il manque des estimations à l'échelle nationale. Les estimations de l'incidence de la MRC ne tiennent souvent pas compte du déclin attendu de la fonction rénale (estimée en fonction du débit de filtration glomérulaire: DFG) associée à l'âge; alors que des seuils adaptés à l'âge pourraient aider à tenir compte de ce phénomène. Nous décrivons ici la fréquence du dépistage et du diagnostic de la MRC chez les adultes diabétiques dans une cohorte de soins primaires représentative au niveau national. Dans cette étude de cohorte rétrospective, nous avons utilisé les données des dossi