Care Processes and Clinical Responses to Newly Detected Albuminuria: The Stockholm Creatinine Measurements (SCREAM) Project.

RATIONALE &

objectiveAlbuminuria is a predictor of adverse health outcomes. Early detection enables timely clinical management, yet little is known about how clinicians respond to newly detected albuminuria in routine practice. This study characterized clinical care processes for patients with newly detected albuminuria. STUDY

designRetrospective, population-based cohort study. SETTING &

participants215,035 adults with newly detected albuminuria between 2010 and 2021 in Stockholm, Sweden. EXPOSURE: Albuminuria severity, categorized as moderate (≥30-299 mg/g), severe (300-999 mg/g), or very severe (≥1000 mg/g). All methods of albuminuria testing were considered: dipstick albuminuria or proteinuria tests as well as 24-hour and spot albumin concentrations. OUTCOME: Proportion of patients retested for albuminuria, frequency of the methods used for retesting, rates of nephrology referral, and rates of initiation of treatment with renin angiotensin system or sodium/glucose cotransporter 2 inhibitors. ANALYTICAL APPROACH: Descriptive analysis of proportions and cumulative incidence of outcomes based on time-to-event analysis accounting for the competing risks of death and kidney failure.

resultsWe found 90% of participants had moderate, 8% had severe, and 2% had very severe albuminuria. Retesting rates within 1 year were 46%, ranging from 45% for moderate albuminuria to 70% for very severe albuminuria, with lower rates among individuals without diabetes. Only 28% of those with an indication were referred to a nephrologist, and renin angiotensin system and sodium/glucose cotransporter 2 inhibitor initiation rates at 1 year were 10%, 12%, and 37% for moderate, severe, and very severe albuminuria, respectively, with substantially lower rates in individuals without diabetes. LIMITATIONS: The findings are specific to Stockholm's health care system and may not be generalizable to other regions, health care models, or cultures.

conclusionsThis study identified important care gaps in the Swedish management of albuminuria. A substantial proportion of individuals, including those with very severe albuminuria, lacked monitoring and failed to receive antiproteinuric treatments. Strategies to improve clinician awareness and adherence to guideline-recommended care may mitigate the long-term consequences of chronic kidney disease progression. PLAIN-LANGUAGE SUMMARY: Early signs of kidney damage, such as albuminuria (protein in the urine) may not always lead to the appropriate clinical follow-up that is recommended in clinical practice guidelines. This study characterized how patients with albuminuria were managed in Stockholm's health care environment. Between 2010 and 2021, 215,035 adults had elevated albuminuria detected for the first time, but many did not receive the recommended follow-up care, including a confirmation test, referral to a nephrologist when indicated, or initiation of kidney-protective medications. This study highlights the need for better strategies to improve care for individuals with albuminuria, ensuring earlier intervention that may prevent more severe health consequences of early indications of kidney damage.