A new chronic kidney disease (CKD) early detection test, created by NHS Innovation Accelerator pioneer Healthy.io, has been rolled out to patients in GP practices that are part of the Modality Partnership, a national group of GP surgeries that have practices in Hull and Airedale, Wharfedale and Craven regions of Yorkshire.
It accomplished 72% adherence among people who didn’t show up for their yearly urine test for more than 18 months. When offered the chance of a home-based test, seven out of ten (72%) used the Healthy.io kit — and one in ten were subsequently found to have signs of kidney damage.
Scaling this model nationally could save the NHS £678.49 million, and prevent 1,361 deaths from kidney disease over five years, a recent study by the York Health Economics Consortium (YHEC) has shown.
Around three million people in the UK have Chronic Kidney Disease (CKD), and as there are no symptoms until there is serious and irreversible damage present, it is estimated that in England alone there are another one million people who have kidney disease who have not been diagnosed.
Early signs of a problem can be easily identified with a urine test called an albumin creatinine ratio (ACR), which measures levels of albumin (a protein which leaches into the urine when the kidneys are not working properly) and the waste product, creatinine. The National Institute for Health and Care Excellence (NICE) recommends that high-risk patients, such as those with diabetes or high blood pressure (hypertension), have an ACR test at least once a year.
However, national audits show that adherence to the yearly ACR test is low. More than 70% of hypertensive people, 50% of people with type 1 diabetes and a third (35%) of those with type 2, who are particularly at risk, are not having these checks.
Screening usually involves sending a urine sample to a laboratory for analysis, but the test allows patients to use a smart-phone app to scan and analyse a test strip in their own home — making testing as simple as taking a selfie.
Dr Andrew Hardy, a GP at the Diadem Medical Practice, which is part of Modality Partnership, says around a third of diabetes patients registered at the practice had failed to provide a sample for ACR testing, and he was initially doubtful about the home-based DIY test.
He said: “I was not too sure whether they would be happy to do the tests themselves, especially as the target population was made up of patients who had not previously engaged with the testing.
“We have tried simple measures such as providing the sample pots and education, with reminders when patients have appointments. Even though the risks of kidney disease are considerable, I don’t think most diabetics consider themselves at risk of kidney disease.
“ACR tests detect kidney damage in an easy non-invasive way, but I don’t think as yet the importance is realised by diabetic patients. There is little awareness of why ACR tests are needed and I am not sure it is often explained well to patients. Most seem to think all urine tests are for testing for infections.”
Detailed analysis at YHEC – a health consultancy and research organisation operated by the University of York – confirms the benefits of encouraging formerly non-compliant patients to use the Healthy.io CKD early detection service.
End-stage disease can be stalled, and in many cases, prevented, through simple measures such as prescribing inexpensive drugs to lower blood pressure, and advising patients to lose weight, get more exercise, quit smoking and cut back on alcohol.
Founder and CEO of Healthy.io, Yonatan Adiri, said: “Our mission is to leverage the simplicity of the Selfie into a clinical-grade scan that drives higher compliance and reduced healthcare costs. Ultimately, kidney disease is a huge healthcare issue both in the UK and across the world. it can have a massive impact on daily quality of life, leading to extreme ill health and greater risk of potentially fatal issues such as stroke, heart attack or complete kidney failure.”