Innovative Use of Point-of-Care Testing for Chronic Kidney Disease Screening

In 2008, Kidney Health Australia conducted a targeted community-based screening program for chronic kidney disease called Kidney Evaluation for You. Point-of-care testing was an integral part of the screening process, along with a lifestyle assessment and an exit interview with a qualified renal nurse. The point-of-care tests performed were creatinine (with calculation of the estimated glomerular filtration rate), glucose, hemoglobin A1c, total cholesterol, hemoglobin, and urine albumin-creatinine ratio. Creatinine measurement, performed on the i-STAT, was aligned with the isotope dilution mass spectrometry reference method before the study. Scientists from the Flinders Community Point-of-Care Services unit delivered training for the renal nurses, developed poster sets on how to use the selected point-of-care devices, and devised a quality control program to monitor the analytical quality of field testing. Screening was conducted at 3 community locations in Australia: Townsville (Queensland), Roxby Downs (South Australia), and Perth (Western Australia). Four hundred two participants were screened, of whom 82 had results suggestive of chronic kidney disease and 39 had an estimated glomerular filtration rate of less than 60 mL/min per 1.73 m. Between-day imprecision (n = 16) averaged 4.5% for creatinine, 0.7% for glucose, 3.2% for hemoglobin A1c, 3.4% for urine albumin-creatinine ratio, 5.1% for cholesterol, and 0.6% for hemoglobin. All point-of-care test results were completed within 9 minutes per subject, whereas approximately 30 subjects were screened per day. Ninety-nine percent of participants indicated that point-of-care testing was convenient for them, and 96% stated that immediate feedback on their results helped them understand their risk of chronic kidney disease.