News|Articles|January 8, 2026

Implementation Gaps Persist in Guideline-Recommended UACR Management in Primary Care: A Conversation with Holly Kramer, MD

A nephrology expert reviews how workflow constraints and care delivery pressures affect adherence to guideline-recommended responses to elevated urine albumin-to-creatinine ratio.

Findings from a recent national survey of 600 primary care physicians (PCPs) showed that only 5% understood the role of urine albumin-to-creatinine ratio (uACR) in predicting cardiovascular risk in patients with type 2 diabetes. Elevated uACR (above 30 mg/g) indicates a significant risk of heart failure, cardiovascular mortality, and myocardial infarction, according to Holly Kramer, MD, MPH, a professor of public health sciences and medicine at Loyola University Chicago who specializes in nephrology. In a recent interview with Patient Care Online, Kramer discussed how current guidelines recommend acting on uACR values of 30 mg/g or higher and why follow-through remains inconsistent in real-world primary care practice. Kramer also emphasizes how workflow pressures, ordering confusion, and competing clinical priorities contribute to missed opportunities for intervention.

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Implementation Gaps Persist in Guideline-Recommended UACR Management in Primary Care: A Conversation with Holly Kramer, MD

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