Diabetic patients ‘reluctant’ to do kidney damage urine test, say clinicians

Author: Caroline White

Patients with type 2 diabetes may be risking their health, because of a reluctance to provide a sample to check for early signs of kidney damage, suggest the results of a survey of GPs and practice nurses, carried out by pharma company Napp Pharmaceuticals.

Over half (54%) of the 403 respondents, 68% of whom were GPs, and 32% nurses, who treat patients with type 2 diabetes, said they don’t carry out the routine test as part of a patient’s annual review.

The Urine Albumin-to-Creatinine Ratio (UACR) test is used to detect protein in the urine, signalling kidney damage that can lead to fatal complications. It is recommended by UK guidelines for diabetes management (NICE and SIGN), but many patients are unwilling to provide a urine sample, according to the survey responses. It was the most commonly reason (38%) cited by clinicians.

Chronic kidney disease has far reaching effects on the body, particularly the heart. Kidney function naturally declines with age, but this decline is faster in 1.9 million patients who also live with type 2 diabetes.

In these patients, any kidney damage results in a 23% increased likelihood of death over 10 years, compared to only 12% for those without kidney damage. The process can be slowed or even halted with the right treatment and lifestyle changes. 

Diabetes is estimated to cost the NHS £14 billion per year, with over 80% of those costs attributable to managing complications of the disease, including those associated with the kidney and the heart. Routine kidney function testing is an important way of identifying those people who are at risk of disease progression.

Dr Kevin Fernando, a GP with specialist interests in diabetes and medical education, at the North Berwick Health Centre said: “The kidneys are often overlooked in favour of the heart in the treatment of [type 2 diabetes]. However, if you protect the kidneys, you can help protect the heart. Any sign of accelerated kidney damage, no matter how early, multiplies the risk of death.

“By making a small change to clinical practice to routinely measure kidney function and motivate patients to provide samples, doctors and nurses have an opportunity to spot damage early and positively intervene in those patients who are identified as being at risk.”

The unwillingness of patients to provide a sample may be because they aren’t aware of the impact of kidney damage on their health, as most patients don’t ask about it in their annual diabetes review. 

Despite 79% of respondents admitting that they knew the UACR test should be used as best practice, three out of four (75%) underestimated the impact of kidney disease on cardiovascular mortality.

But 85% felt that colleagues would be more likely to carry out kidney function testing if they were aware of the true increase in risk of death. 

A spokesperson from the National Kidney Federation said: “Effective diabetes management means more than just blood sugar control. So many patients and doctors are unaware that kidney damage is occurring and just how serious it can be for someone with diabetes.

“If patients knew the true impact of kidney disease, they may be more willing to provide a urine sample to help prevent further decline. We call on patients to learn about their health and for doctors and nurses to take the time to explain that by giving a urine sample we can identify any kidney disease, to monitor its progression and predict future health.”

Dr Aisling McMahon, executive director for research, innovation and policy at charity Kidney Research UK said: “These survey results are sadly unsurprising, indeed they bear out findings from our own research among people with diabetes. Large numbers of people within this patient group are unaware that they are at increased risk of developing kidney problems, and how life-limiting those kidney problems can become.

“Having a simple urine test can help diagnose kidney problems early, and treatment and adjustments to lifestyle can make an enormous difference.”