What question did this study set out to answer?

This trial aims to evaluate the effectiveness of an electronic alert system for increasing UACR testing in patients with type 2 diabetes.

April 25, 2026Open Access

Electronic Alert-Based Computerized Decision Support for Detection of Chronic Kidney Disease in Type 2 Diabetes Mellitus: The CKD-DETECT Randomized Trial

Key Points

This trial aims to evaluate the effectiveness of an electronic alert system for increasing UACR testing in patients with type 2 diabetes.
Randomized clinical trial involving outpatients aged ≥18 with type 2 diabetes and no prior UACR testing.
Physicians received alerts for UACR testing or none (control) to measure orders within 90 days.
Primary outcome was UACR orders; secondary included new chronic kidney disease diagnoses.
UACR was ordered in 36.0% of the alert group vs. 11.5% of the control group (OR 5.71; 95% CI 2.58–12.64; P<0.001).
New chronic kidney disease diagnoses were minimal, with 0.5% in the alert and 1.0% in the control (OR 0.50; 95% CI 0.04-5.53; P=0.570).
Alert group showed higher identification of UACR ≥10 mg/g (21.0% vs. 8.5%; OR 3.41; P=0.008) and ≥30 mg/g (9.5% vs. 4.0%; OR 3.71; P=0.011).

Abstract

AbstractBackground : Urine albumin-to-creatinine ratio (UACR) provides a reliable method for chronic kidney disease screening in patients with type 2 diabetes, yet its use remains underutilized. Methods : The CKD-DETECT randomized clinical trial included outpatients ≥18 years with type 2 diabetes without UACR testing in the prior 12 months and no chronic kidney disease. Physicians were randomized to receive either an alert prompting UACR testing or no alert (control). The primary outcome was the proportion of UACR orders within 90 days. The secondary outcome was new chronic kidney disease stage 3–5 diagnoses. Tertiary outcomes were referral to a nephrologist and prescription of chronic kidney disease-related medications, and post-hoc outcomes were UACR ≥10 mg/g and ≥30 mg/g. Results : Overall, 400 patients (mean age 64.7 years; 51.5% female) were included. UACR was ordered in 72 (36.0%) patients in the alert group vs. 23 (11.5%) in the control group (odds ratio OR 5.71; 95% confidence interval CI 2.58–12.64; PConclusion : The alert-based CDS program was associated with increased UACR testing and early detection of elevated albuminuria in patients with diabetes. Clinical trial registration : ClinicalTrials.gov identifier, NCT05342545 (prospectively registered on April 18, 2022) Funding : This work was supported by a research grant from Bayer.

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