Background: Data indicate lack of CKD awareness in T2D. Our study aimed to determine whether physician awareness of CKD in T2D is associated with CKD severity, and whether this changed over time.

Methods: Retrospective study of adults (≥ 18 years) with an electronic health record (EHR) T2D diagnosis (Dx), seen in clinic in 3 sequential periods: 1/1/11-6/30/13, 7/1/13-12/31/15, and 1/1/16-6/30/19. CKD stages were defined by estimated glomerular filtration rate (eGFR; CKD-EPI creatinine-based) and albumin-to-creatinine ratio (ACR, spot urine). G1-G5 indicates eGFR CKD stages (mL/min/1.73m2) G1 >90, G2 89-60, G3a 45-59, G3b 30-44, G4 15-29, and G5 <15. A1-A3 indicates ACR stages (mg/g) A1 <30, A2 30-300, and A3 >300. The frequency of CKD stages was determined for all participants, regardless of EHR CKD Dx.

Results: From 136,157 eligible patients (62±15 years; 53% male) seen during the study period, 77.9% had eGFR measured, 60.6% ACR, and 58.8% both. ACR was measured more often in less severe CKD stages (Chi-Square, p<0.001). For example, in period 1, ACR was assessed in 82.1%, 80.2%, 76.7%, 76.2%, 66.9%, and 48.1% from G1-5, respectively. Patients in G3a less often had a CKD Dx on their problem list than those in G3b-5 (Chi-Square, p<0.001). Among patients in G3a an EHR CKD Dx was present in 53.8%, 58.4%, and 60.1%, while among those in G3b-5 an EHR CKD Dx was present in 79.8%, 85.6%, and 84.9% in periods 1-3, respectively. Considering all patients in A2-3, an EHR CKD Dx was present in 44.9%, 44.5%, and 45.7% in periods 1-3, respectively.

Conclusions: Consistent with published data, most patients with T2D and lab-diagnosed CKD do not have a CKD Dx in the EHR. Our study indicates that physician’s CKD awareness is associated with CKD severity as related to eGFR but not to ACR. Our data also indicates that despite an initial increase in eGFR-driven CKD awareness between periods 1 and 2, this has leveled off. Not having an EHR CKD Dx suggests lack of physician (and patient) CKD awareness and can potentially lead to suboptimal care.


J. Schempf: None. R.L. Freese: None. L. Caramori: Speaker’s Bureau; Self; Bayer Inc. Other Relationship; Self; Bayer Inc., Novartis Pharmaceuticals Corporation. T. Harindhanavudhi: None.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at