Improving Kidney Health Outcomes for People with Diabetes

Chronic kidney disease (CKD) is a common and serious complication of diabetes, yet gaps persist in early detection, diagnosis, and treatment. An initial analysis at Sanford Health, which was presented at the NCQA Health Innovation Summit in San Diego, CA, revealed low rates of urine albumin-creatinine ratio testing, underdiagnosis of CKD in primary care, and limited prescribing of sodium-glucose cotransporter-2 inhibitors (SGLT2i).

To close these gaps, the National Kidney Foundation (NKF) and Sanford Health collaborated on a system-wide quality improvement program informed by the NKF CKD Change Package. Interventions included implementation of the NKF-recommended Kidney Profile for laboratory testing, updates to electronic health record (EHR) SmartSets to support guideline-directed testing and treatment, and integration of clinician and patient education resources within the EHR. CKD testing was also added to the EHR health maintenance menu. The program was launched in December 2023 with a series of continuing medical education webinars.

By October 2024, the initiative had demonstrated significant impact. The percentage of people with diabetes receiving guideline-concordant CKD testing increased from 38% to 70%. The proportion of patients with laboratory evidence of CKD who also had an ICD-10 diagnosis rose from 20% to 73%. Prescribing of SGLT2i therapy among patients with CKD increased from less than 2% to nearly 10%. These results underscore how system-level interventions can improve outcomes while addressing operational and financial challenges associated with CKD care.

Speakers include Caroline Blaum, MD, MS, assistant vice president of chronic conditions and complex care at NCQA; Jennifer Lamprecht, MHA, director of quality strategy at Sanford Health; Elizabeth Montgomery, MPH, national vice president of clinical practice innovation and population health at the NKF; and David White, patient partner and kidney health advocate.

Reference:
NCQA Health Innovation Summit. Improving Chronic Kidney Disease Detection and Care. NCQA; October 13, 2025. Accessed September 29, 2025. https://events.ncqa.org/summit2025/session/3250348/improving-chronic-kidney-disease-detection-and-car