An electronic health record (EHR)-integrated, alert-based computerized decision support (CDS) tool contributes to increased urine albumin-to-creatinine ratio (UACR) testing and early detection of elevated albuminuria among adults with type 2 diabetes (T2D), as shown in the CKD-DETECT trial.
“Implementation of CDS tools can improve the screening of diabetic kidney disease in patients with T2D,” the investigators said. [Am J Med 2026;139:1228-1236]
Some 400 patients (mean age 64.7 years, 51.5 percent female) with T2D without UACR testing in the prior 12 months and no chronic kidney disease (CKD) were included in the trial. Physicians ordered UACR in 72 patients (36.0 percent) in the alert group and in 23 (11.5 percent) in the control group (odds ratio [HR], 5.71, 95 percent confidence interval [CI], 2.58‒12.64; p<0.001).
One (0.5 percent) patient in the alert group and two (1.0 percent) in the control group had new diagnoses of CKD (OR, 0.50, 95 percent CI, 0.04‒5.53; p=0.570). No referrals to nephrologists or new prescriptions of CKD-related medications were recorded.
Furthermore, significantly more patients in the alert group had increased identification of UACR ≥10 mg/g (21.0 percent vs 8.5 percent; OR, 3.41, 95 percent CI, 1.37‒8.48; p=0.008) and ≥30 mg/g (9.5 percent vs 4.0 percent; OR, 3.71, 95 percent CI, 1.36‒10.12; p=0.011) than those in the control group.
“Given the importance of early CKD identification in slowing the progression to kidney failure and reducing cardiovascular morbidity, these findings support the broader implementation of CDS-enabled screening strategies to manage patients with T2D,” the investigators said.
Early detection
Increased detection of abnormal UACR values is clinically significant, since even low-grade albuminuria can lead to elevated risks of CKD progression, cardiovascular events, and mortality. [Eur J Prev Cardiol 2024;31:2046-2055]
Recognizing abnormal UACR values early allows physicians to initiate or intensify nephroprotective therapies in patients and to adjust interventions for blood pressure, nutrition, glycaemic control, and other heart-healthy lifestyle interventions, “with the goal of retarding kidney function decline and reducing cardiovascular morbidity.” [Eur Heart J 2023;44:1112-1123]
“The principal value of enhanced UACR screening lies in early identification and management of kidney injury rather than changes in chronic kidney disease stage classification,” the investigators said.
“Future studies with longer follow-up are needed to determine whether increased and earlier detection of albuminuria leads to slower estimated glomerular filtration rate decline and lower incidence of kidney failure,” they added.
System improvement
The investigators also pushed for further refinements of CDS systems for CKD screening.
“Advances in machine learning and natural language processing may improve identification of patients at the highest risk for early CKD progression, through integrated evaluation of longitudinal laboratory patterns, blood pressure trajectories, medication profiles, and other EHR-derived signals,” the investigators said. [Sci Rep 2019;9:11862; J Am Soc Nephrol 2026;37:881-890]
“Risk-stratified or adaptive CDS strategies could decrease unnecessary alerts, increase personalized recommendations, and mitigate alert fatigue,” they added.
The CKD-DETECT trial randomized physicians to receive either an alert prompting UACR testing or no alert (control). The proportion of UACR orders within 90 days was the primary outcome, while new diagnoses of CKD stage 3‒5 were secondary. Other outcomes assessed were referrals to a nephrologist, prescription of CKD-related medications, and UACR ≥10 and ≥30 mg/g.