The National Kidney Foundation and Manatt Health released an analysis showing that while Medicare screening for kidney disease has increased since 2016, many patients still lack proper testing in early stages of chronic kidney disease (CKD). Between 2016 and 2023, testing rates climbed, but this did not lead to earlier diagnoses for most patients.
The report reveals a persistent imbalance in testing methods. A full CKD evaluation requires both an estimated glomerular filtration rate (eGFR) blood test and a urine albumin-to-creatinine ratio (uACR) urine test. However, uACR testing remains far too rare: only 20% of Traditional Medicare beneficiaries received both tests in 2023, up from 17% in 2016. Medicare Advantage enrollees performed better, with 28% receiving both tests in 2023 compared to 24% seven years earlier.
Despite the rise in screening, the share of patients diagnosed at early CKD stages, G1 or G2, has not improved significantly. Early detection is essential because it allows for timely risk assessment and treatment with therapies that can slow disease progression, potentially avoiding or delaying dialysis. Yet the data indicate that more frequent testing alone does not ensure earlier identification of CKD.
Joseph Vassalotti, MD, the National Kidney Foundation’s chief medical officer, highlighted the critical role of uACR testing. “I think that the key issue is that the [uACR] is fundamental and the [uACR] is often missing,” he said. The analysis showed eGFR testing was far more common, with rates exceeding 80% in most years. Michal Melamed, MD, director of NYU Langone’s Chronic Kidney Disease Center, noted that while urine testing is simple and widely accepted by patients, it remains underused compared to blood tests.
Medicare Advantage enrollees consistently showed higher rates of full testing than those in Traditional Medicare. Researchers linked this difference to variations in care management, coding practices, and financial incentives. The report recommends further investigation into testing rates among high-risk groups, such as individuals with diabetes or hypertension, as well as the effects of payment incentives on diagnosis and patient outcomes.
One positive development was improved CKD staging precision. Between 2017 and 2023, the percentage of newly diagnosed patients with an unspecified CKD stage dropped from 42% to 33% in Traditional Medicare and from 40% to 35% in Medicare Advantage. Better staging enables more targeted treatment, referrals, and follow-up care, which can enhance patient outcomes.