A SMARTPHONE SCREENING TEST FOR CHRONIC KIDNEY DISEASE WHICH WILL SAVE LIVES AND HUNDREDS OF MILLIONS OF POUNDS
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.
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 simple 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 per cent of hypertensive people, 50 per cent of people with type 1 diabetes and a third (35 per cent) of those with type 2, who are particularly at risk, are not having these potentially life-saving checks.
Screening usually involves sending a urine sample to a laboratory for analysis, but the ground-breaking new test, developed by health-tech specialists Healthy.io 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.
Identifying these patients allows management of their kidney disease whilst minimising further damage — which can have a huge impact in terms of reducing their risk, not only of kidney failure but also of other potentially chronic conditions, such as heart disease and stroke.
This service has just been rolled out at Modality Partnership, a national group of GP surgeries. They have tested it out with patients in the Hull and Airedale, Wharfedale and Craven region of Yorkshire, where in the past, 2,196 patients with diabetes had failed to provide samples for ACR testing. 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.
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. “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,” he says.
“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.”
He admits: “It can be very frustrating that an important measure of kidney damage is not being performed.”
Detailed analysis by experts 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.
Their analysis found that if the ACR Home Based Urine test was used across England, in just five years it would:
- Save the NHS £678.49 million.
- Prevent 33,723 cases of CKD
- Prevent 1,361 deaths, and
- Spare 11,376 people from end-stage renal disease, when they require regular dialysis, or a kidney transplant.
End-stage disease can be stalled, and in many cases, prevented, through simple measures such prescribing inexpensive drugs to lower blood pressure, and advising patients to lose weight, get more exercise, quit smoking and cut back on alcohol.
Dr Andrew Hardy says: “We can counsel them again about the importance of good diabetic control through weight management and physical activity. Medication advice would include ACE inhibitors or angiotensin receptor blockers to protect the kidneys.”
Dr Gill Jenkins, a GP who also has diabetes, says: “Perhaps it’s because there is so much focus on controlling blood sugar levels, but many patients don’t seem to realise how important ACR tests are.
“It can be a struggle to get patients tested. We ask them to bring a sample, but if they forget, they may not be able to produce one when they are at the surgery. The advantage of Healthy.io test is that it is very simple and can be done at home.”
She says: “There is a perception among patients, and even some medical staff, that blood trumps urine, and if you have had a blood test you don’t need a urine test. But that is not the case.”
Founder and CEO of Healthy.io, Yonatan Adiri, says: “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.”
The ACR test is one of several that Healthy.io has developed which leverage the smartphone camera to extend access to colour-based clinical tests.