Impact of smartphone-enabled home urinary albumin-to-creatinine ratio testing on albuminuria screening and management

ABSTRACT Objective We investigated the impact of smartphone-enabled home urinary albumin creatinine ratio (UACR) testing on albuminuria screening and management in a prospective propensity score-matched cohort study. Research design and methods We randomly selected 4000 adult individuals (50% with hypertension but no diabetes; 50% with diabetes) receiving primary care at a large, regional health system to receive Minuteful Kidney, an FDA-cleared, smartphone-enabled home UACR test kit. A total of 3998 individuals in the intervention program were matched 1:1 to 3998 in the control group receiving usual care, using propensity score matching including sociodemographics and comorbidities. The primary outcome was completion of UACR test (either lab-based or home testing) within 100 days of program start. Results Overall, completion of any UACR test was higher in the intervention program than the control group for the hypertension subgroup (53% vs. 13%) and the diabetes subgroup (53% vs. 30%). Increase in UACR testing associated with Minuteful Kidney was consistent across age, sex, race, and ethnicity subgroups though lower in non-users of the patient portal. Minuteful Kidney UACR results were abnormal (≥30 mg/g) in 38% (330/872) in the hypertension subgroup and 45% (306/682) in the diabetes subgroup. Among 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. Conclusion A convenient smartphone-enabled home albuminuria test is effective in increasing albuminuria screening among high-risk individuals. Twitter summary Home urine tests using smartphones boosted kidney screening rates 2.5x vs. usual care. Early detection can result in better follow-up and treatment to prevent heart and kidney problems. #kidneyhealth Why did we undertake this study? - We undertook this study to see if we could improve early detection of kidney disease through at-home albuminuria screening. What is the specific question(s) we wanted to answer? - We wanted to know whether a smartphone-enabled home urine test could increase screening rates. What did we find? - Home testing significantly increased test completion (53.1% vs. 21.2%), and there were some early suggestions of improved diagnosis and follow-up care. What are the implications of our findings? - Home testing for albuminuria can enhance early detection of kidney disease, which could lead to earlier identification, management and potentially long-term outcomes.