Impact of Smartphone-Enabled Home Urinary Albumin-Creatinine Ratio Testing on Albuminuria Screening and Management

Abstract

Rationale & Objective

Early detection of albuminuria can enable administration of therapeutic interventions that improve clinical outcomes in patients at elevated risk for chronic kidney disease (CKD). We investigated the impact of smartphone-enabled home urinary albumin-creatinine ratio (UACR) testing on albuminuria screening and clinical management of these patients.

Study Design

Nonrandomized clinical trial.

Setting & Participants

Active intervention group comprised 3,998 randomly selected adults (50% with hypertension but no diabetes; 50% with diabetes) receiving primary care at a large, regional health system compared with 3,998 propensity score–matched controls who were receiving usual care.

Interventions

Minuteful Kidney, a smartphone-enabled home UACR test kit cleared by the US Food and Drug Administration.

Outcome

The primary outcome was completion of UACR testing (either laboratory-based or home testing) within 100 days of program start.

Analytical Approach

Covariate balance between matched groups was evaluated using the standardized mean difference (SMD). Outcomes were compared between the 2 matched groups using McNemar’s test.

Results

Overall, completion of any UACR test was higher in the intervention program than in the control group for the hypertension subgroup (53% vs 13%) and the diabetes subgroup (53% vs 30%). Greater UACR testing with Minuteful Kidney was consistent across age, sex, race, and ethnicity subgroups, though lower in nonusers of the patient portal. The Minuteful Kidney UACR results were abnormal (≥30 mg/g) in 38% (330 of 872) in the hypertension subgroup and in 45% (306 of 682) in the diabetes subgroup. Among the Minuteful Kidney–tested individuals, those with abnormal UACR were more likely to have follow-up primary care and nephrology visits and new prescriptions of renin-angiotensin-aldosterone system inhibitors than those with normal UACR.

Limitations

Despite random assignment to intervention, this was not a randomized study; intervention was limited to 1 large rural health system; use of glucagon-like peptide-1 receptor agonists in CKD was not assessed.

Conclusions

A convenient smartphone-enabled home albuminuria test is effective in increasing albuminuria screening among high-risk individuals.

Plain Language Summary

This study evaluated whether a smartphone-enabled home albuminuria test could improve chronic kidney disease (CKD) screening among adults with hypertension or diabetes. We found that home testing increased albuminuria test completion 2.5-fold in the intervention group compared with the control group (53% vs 21%). The impact was larger in the hypertension-only subgroup (53% vs 13%) than in the diabetes subgroup (53% vs 30%). Among those tested at home, 38% (hypertension subgroup) and 45% (diabetes subgroup) had abnormal albuminuria levels. These individuals were more likely to have follow-up care and new prescriptions for certain kidney-protective medications. These findings support the use of home albuminuria testing as an effective strategy to increase screening and early intervention for kidney disease in high-risk populations.