Research Award Recipients

Do community laboratory-based prompts help improve primary care for patients with chronic kidney disease? A population-based interrupted time series in Ontario.

Co-applicant(s): Amber Molnar, Amit X Garg, Ann Young, Arsh Kumar Jain, Brenden Cote, Craig Lindsay, K Scott Brimble, Lihua Li, Matthew Weir, Merrick Flynn Zwarenstein, Peter Blake

Lay Abstract

Background: Chronic kidney disease often develops silently until the kidneys are close to failing. At that point, people need dialysis or a kidney transplant to survive. Dialysis cleans the blood but can cause serious side effects and greatly affects quality of life. Finding and treating chronic kidney disease early is the best way to prevent kidney failure. Doctors use two tests to detect kidney disease: a blood test to measure kidney function and a urine test to check for protein, which signals kidney damage. While most people get the blood test, only about half with reduced kidney function have the urine test. Both tests are needed to properly diagnose kidney disease and determine how severe it is. Family doctors can generally care for patients with kidney disease, but patients should see a kidney specialist if kidney function falls below 30% or if urine protein is high. Unfortunately, 1 in 4 patients do not see a kidney specialist or first see one less than 90 days before starting dialysis—too late to slow the disease.

Purpose: In May 2024, the Region: Ontario government partnered with community labs, such as Dynacare and LifeLabs, to add advice messages to lab reports. These messages appear for both doctors and patients when results suggest kidney disease or when a referral is recommended. For example, if a person’s kidney function is very low, the report may state: “Referral to a kidney specialist is recommended.” This study will test whether these new lab report messages lead to: 1) more urine protein testing to diagnose chronic kidney disease; 2) more referrals to kidney specialists; and 3) greater use of kidney-protective medications to help prevent kidney failure.

Methods: We will use Region: Ontario-wide health data from ICES, a not-for-profit research institute that securely holds de-identified health records. These data include doctor visits, community lab test results, hospital and emergency room visits, and prescription information. Using this data, we will compare how often people had urine protein tests, kidney specialist referrals, or kidney-protective medications prescribed before and after the lab messages began (May 1, 2024). We will also examine whether the impact differs by age, sex, rural location, income level, or whether the person has a family doctor.

Anticipated Outcomes: We expect that lab-based messages will increase urine protein testing, referrals to kidney specialists, and medications to protect the kidneys, helping doctors find kidney disease earlier and manage it more effectively. We also expect that females, older adults, individuals living in more rural or lower-income areas, and those with a family doctor will be most impacted by these messages.

Patient Engagement: People with lived experience of kidney disease helped shape the study’s questions and methods. They will stay involved throughout the project—offering input on study design, interpreting results, and helping to create materials to share findings with patients and the public.

Relevance to Patients/Community: Finding kidney disease earlier and getting more timely care by a kidney specialist can slow or prevent kidney failure and reduce the need for urgent dialysis. Because dialysis is expensive and has major effects on daily life, better prevention benefits both patients and the healthcare system.

Conclusion: This study will test whether lab messages improve care for patients with chronic kidney disease. If this approach is effective, it could guide other provinces in improving kidney care using simple, low-cost changes to lab reports.