The albumin-to-creatinine ratio test allows chronic kidney disease to be diagnosed before the first symptoms appear. This test, performed using a urine sample, makes it possible to easily measure the presence of the protein albumin in the kidneys, which may indicate that these organs are not functioning properly.
Despite the effectiveness of the test and the ease with which it can be performed, it is only carried out in one out of every three people undergoing screening for chronic kidney disease in primary care. This is the conclusion of a study led by researchers from the Girona Research Support Unit of the IDIAPJGol and the Institut Català de la Salut, recently published in the journal BMC Primary Care.
The study is based on a descriptive analysis of anonymized electronic health record data and includes a sample of 230,922 individuals aged 15 years or older who were treated at 18 primary care centers in the Girona South Primary Care Subdivision up to December 31, 2024. This large dataset provides a realistic picture of everyday clinical practice and helps identify differences in screening according to risk profile.
Uneven screening
The results show that while screening based on estimated glomerular filtration rate (a test that measures how much blood the kidneys filter per minute) is quite common (approximately 70% of the population had at least one measurement), albumin-to-creatinine ratio testing is performed far less frequently (in fewer than 32% of individuals). This difference is relevant because albuminuria may appear in the early stages of kidney disease, when symptoms have not yet developed, and it provides information that helps stratify patient risk and guide preventive measures.
When risk factors are analyzed, screening rates are particularly high among people with type 2 diabetes and hypertension. In contrast, other groups also at high risk of kidney disease—such as people with obesity or smokers—have lower screening coverage, especially regarding albumin-to-creatinine ratio testing.
Missed opportunities
The study also describes the use of renoprotective treatments (such as ACE inhibitors/ARBs and SGLT2 inhibitors) and notes that they are prescribed mainly in the early stages of the disease, while their use declines in more advanced stages.
Joan Barrot-de la Puente, a researcher at the IDIAPJGol and first author of the article, points out that “their underuse in more advanced stages of chronic kidney disease highlights missed opportunities for timely and optimal intervention.”
The study concludes that progress is needed toward a more systematic, risk-based approach, incorporating structured testing pathways, electronic health record alerts, and clinical decision support tools to improve early detection and management of chronic kidney disease in primary care.
Article reference
Barrot-de la Puente J, Lopez Arpí C, Ramon Granes M, Escribà Planes M, Fernandez-Camins B, Vlacho B, Franch-Nadal J. Chronic kidney disease screening in primary care: a descriptive analysis of the Girona Sud health region. BMC Prim Care. 2025 Nov 24;26(1):409. doi: 10.1186/s12875-025-03117-0. PMID: 41276836; PMCID: PMC12750594.
