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

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.