Closing the CKD Testing Gap: How the National Kidney Foundation Is Moving the Needle

Consistent annual gains in CKD testing among people with diabetes across every insurance segment tell a compelling story - and the National Kidney Foundation’s (NKF) CKDintercept™ strategy deserves much of the credit.

The National Committee for Quality Assurance (NCQA) recently released performance data regarding the Kidney Health Evaluation for Patients with Diabetes (KED) Healthcare Effectiveness and Data Information Set (HEDIS) measure which assesses the rate of people with diabetes that receive both serum creatinine with eGFR (eGFR) and urine albumin-creatinine ratio (uACR) testing each year (the two tests needed to appropriately diagnose and stage chronic kidney disease (CKD). This data, tracking annual kidney testing rates from 2021 to 2024, shows consistent, meaningful improvement in CKD testing across every major insurance segment — Commercial HMO, Commercial PPO, Medicaid HMO, Medicare HMO, and Medicare PPO. As a result—as many as 2 million additional people had appropriate kidney screening needed to identify, diagnose and treat kidney disease early. * While no single factor explains the trend, the sustained advocacy, clinical education, and quality measure work of the NKF has been central to driving it.

^{* This number is an approximation based on prevalence of adults with diabetes and number of covered lives in each plan type.} 

Consistent year-over-year gains across every payer type suggest systemic change, not noise. That kind of movement across such a heterogeneous population requires deliberate, coordinated effort.

In 2018, NKF’s CKDintercept leadership recognized that the significant clinical inertia that existed in CKD would not be addressed until the gaps in CKD testing were addressed and financial incentives provided for clinicians to prioritize CKD care. The majority of people with kidney disease were undiagnosed and fewer than 40% of people with diabetes had appropriate kidney testing done annually, despite strong clinical guidelines recommended it. 

Recognizing the power and reach of the NCQA, NKF invited them to collaborate on the development of a set of quality measures that would illuminate the significant gaps that existed in CKD testing.  The Kidney Health Evaluation for Patients with Diabetes HEDIS and Merit Incentive Program (MIPS) measures arose from this collaboration. The HEDIS measure was released in July 2020, and KED measure was accepted into MIPS in 2023.  In 2024, the KED was included in the Medicare Advantage and Part D Star Ratings, increasing the importance of this measure for health plans and clinicians.

To support these efforts, CKDintercept offers a suite of tools to help clinicians and payers navigate the process that leads to improved outcomes for people living with kidney disease including the NKF CKD Change Package, CKD Data Strategy, and CKD Learning Collaborative.

Operational implications

• Testing rates remain well below 60% among people with diabetes even in the highest-performing segments — significant room for improvement persists across the board. (Rates of testing in hypertension are less than 25%)
• Medicaid HMO represents the largest equity gap and the highest-yield opportunity for targeted outreach and care gap closure programs  
• NKF partnership programs offer turnkey resources for health systems, health plans and ACOs looking to accelerate quality measure performance. 
• Multi-year momentum suggests that investments in kidney health infrastructure compound over time — the trend lines do not appear to have plateaued.

For health systems and payers watching these numbers, the message is encouraging but not complacent. Reaching 70% or 80% testing rates will require more than awareness campaigns. It will demand workflow integration — embedding kidney testing into diabetes and hypertension management protocols — as well as continued reimbursement alignment that rewards preventive nephrology rather than just downstream dialysis care.  NKF has demonstrated success in helping care delivery partners improve outcomes in CKD testing and care (link to Sanford).

The kidney testing trend documented in this data is quiet, incremental, and easy to overlook in an industry often drawn to dramatic breakthroughs. But those four to nine percentage-point gains, replicated across every payer segment for three consecutive years, represent millions of new patients who now have been tested – a vital step in improving CKD diagnosis and management — and with them, a chance at a different outcome.