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Home testing app to screen for chronic kidney disease for people with diabetes across West Yorkshire and Harrogate Health and Care Partnership

A smartphone app and home test kit enabling people to test themselves for chronic kidney disease (CKD) using their mobile phone camera is now being rolled out across all GP practices in West Yorkshire and Harrogate Health and Care Partnership. It has been made possible through a collaboration with health technology partner Healthy.io and the Accelerated Access Collaborative (AAC), NHSX and the National Institute of Health Research (NIHR).

As GP surgeries continue to face immense pressures as a result of the coronavirus (COVID-19) pandemic and ongoing vaccination roll-out, West Yorkshire and Harrogate join a growing number of NHS organisations across the country who are using this digital innovation to reduce the burden on the primary care workforce and enable at-risk patients to complete urine tests safely from home.

This follows a successful trailblazing project in NHS Leeds CCG, that saw 1,000 patients perform a home urinary albumin to creatinine ratio (ACR) test and identified 235 previously untested patients as having clinically significant results (13 per cent of the eligible patient cohort). The expansion to the whole West Yorkshire and Harrogate Health and Care Partnership signifies a step towards enabling more at-risk patients to complete urine tests safely and easily from home and reduce the burden on the primary care workforce.

The chronic kidney disease early detection service uses image recognition and computer vision technology to turn the smartphone camera into a clinical-grade medical device, allowing people with diabetes to complete their annual ACR urine test at home, without needing to visit the GP’s practice. 

Urine testing for kidney health has the least uptake of all nine tests which are recommended by NICE and NHS England as part of the annual diabetes review.  Whilst the test is clinically critical, 60 per cent of people living with diabetes do not engage in the care process through the traditional models of care. It is estimated that 78,964 people across West Yorkshire and Harrogate Health and Care Partnership do not complete their annual urine ACR test.  Now, all patients with diabetes who have not completed a test in the last 12 months, are being invited to take part in the new home testing programme.

Why the service is important
One in ten people in the UK suffer from chronic kidney disease, a long-term condition where the kidney functions gradually decline, costing the NHS £1.5 billion annually to treat. It is often difficult to spot symptoms until it has reached an advanced stage. People with the condition have a greater risk of having a stroke or heart attack. It can also cause kidney failure, when sufferers will need to have dialysis and a possible transplant.

However, lifestyle changes and medication can stop it getting worse if it's diagnosed at an early stage.

For high-risk populations such as people living with diabetes or hypertension, a yearly urine test to monitor ACR can detect early signs. Until now this has only been possible by providing a urine sample in person at a doctor’s surgery, medical centre or hospital.

Despite its importance, 6.8 million people at risk in the UK don’t complete the annual test. The current COVID-19 pandemic has exacerbated the problem, as people who are at risk are often medically vulnerable and can be anxious to leave home.

This means many cases of chronic kidney disease are not being detected until they’re at an advanced stage, sometimes when a person is suffering from end stage renal disease and needs a transplant or dialysis.

According to research, the app could prevent more than 11,000 cases of end-stage kidney disease in the UK and save the NHS £660 million in five years.  The health economics evaluation of the original service pilot, delivered by York Health Economics Consortium, also suggested that offering home-testing to the at-risk population across West Yorkshire and Harrogate Health and Care Partnership could save the local NHS £4,276,885 over five years and help to detect over 1,169  new cases of CKD. 

The service has been commended for how easy it is to use. In a recent deployment in Leeds, after six weeks of testing, 93 per cent of participants were reporting the test “very easy” or “easy” to use. Patients up to the age of 94 have successfully downloaded the app and completed the test from home. 

How the service works
After being identified by their GP or local health service as someone at high risk of chronic kidney disease who hasn’t had an ACR test in the last year, patients are contacted by Healthy.io to help them download the ‘Minuteful - kidney test’ app and answer any questions they may have. 
 
They are then sent an ACR home based urine test called ‘Minuteful’ by next day post, which includes a standard dipstick, a urine collection pot in which they dip the stick after giving a sample and a patented colour board.
 
They download the app onto their phone, which then guides them through the test, including how to scan the dipstick on the colour board with their mobile phone camera. Using artificial intelligence (AI) and colourimetric analysis, an algorithm reads the dipstick results with accuracy equivalent to a lab-based device. Then, the app sends a real-time clinical grade result to the user’s GP or clinician directly, so they can follow up with the patient with a diagnosis and treatment plan.