Why Guideline-Recommended uACR Screening Is Still Being Missed, With Payal Kohli, MD

Urine albumin-to-creatinine ratio (uACR) testing has long been recommended in clinical guidelines from leading health care organizations, however, it remains significantly underutilized in routine practice. National estimates suggest that fewer than half of eligible adults receive regular albuminuria screening. This gap is particularly concerning given that albuminuria is often present long before estimated glomerular filtration rate (eGFR) declines, allowing early kidney damage and cardiovascular risk to go undetected.^1-2

Cardiologist Payal Kohli, MD, sat down with Patient Care Online and discussed how both awareness and implementation barriers contribute to missed uACR testing.

Payal Kohli, MD, is the founder and medical director of Cherry Creek Heart​ in Aurora, Colorado, and associate adjunct professor in the division of cardiology at Johns Hopkins University.

References:

1. Albekery MA, Alhomoud IS, Alabdulathim LS, et al. Underutilization of albuminuria screening in adults with diabetes mellitus or hypertension: a systematic review and meta-analysis. BMC Nephrol. 2025;27:18. doi:10.1186/s12882-025-04672-5
2. Ferrè S, Storfer-Isser A, Kinderknecht K, et al. Fulfillment and Validity of the Kidney Health Evaluation Measure for People with Diabetes. Mayo Clin Proc Innov Qual Outcomes. 2023;7:382-391. doi:10.1016/j.mayocpiqo.2023.07.002