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This one-year cross-sectional intervention assessed the feasibility, diagnostic yield, clinical actions, and laboratory reagent costs of a clinical decision support system–enabled opportunistic screening program using an albuminuria-first approach with eGFR. 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Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license.  \n1 Clinical Laboratory, Hospital Universitario de San Juan, 03550 San Juan de Alicante, Spain; [lopez_marter@gva.es](lopez_marter@gva.es) (M.L.-G.); [gutierrez_ire@gva.es](gutierrez_ire@gva.es) (I.G.); [mariasalinaslacasta@gmail.com](mariasalinaslacasta@gmail.com) (M.S.)  \n2 Diagnostic Innovation in Laboratory Medicine Group, FISABIO, Avda. Cataluña, 21, 46020 Valencia, Spain  \n3 Department of Biochemistry, Universidad Miguel Hernandez, 03202 Elche, Spain  \n4 Centro de Investigación Biomédica en Red (CIBER) Epidemiología y Salud Pública (ESP), 28029 Madrid, Spain  \n5 Primary Care, Department Alicante-Sant Joan, 03550 San Juan de Alicante, Spain; puig_est@gva.es (E.P.); [sanchez_selgra@gva.es](sanchez_selgra@gva.es) (S.S.)  \n6 Department of Nephrology and Hypertension, Universidad Autónoma de Madrid (IIS-FJD, UAM),  \n28040 Madrid, Spain; [alberto.ortiz@uam.es](alberto.ortiz@uam.es)  \n7 Health Research Institute—Fundación Jiménez Díaz University Hospital, Universidad Autónoma de Madrid (IIS-FJD, UAM), 28040 Madrid, Spain  \n8 RICORS2040-Renal, Instituto de Salud Carlos III, 28029 Madrid, Spain  \n9 Departamento de Medicina, Facultad de Medicina, Universidad Autónoma de Madrid, 28049 Madrid, Spain  \n10 Department of Clinical Medicine, Universidad Miguel Hernandez, 03202 Elche, Spain  \n* Correspondence: flores [emi@gva.es](emi@gva.es); Tel.: +0034-965-169-465  \nAbstract  \nBackground/Objectives: CKD affects over 10% of adults and is often silent, delaying diagnosis. Opportunistic primary care screening supported by clinical decision support systems (CDSSs) may improve detection with minimal burden. We evaluated the feasibility, diagnostic yield, clinical actions, and reagent costs of a CDSS-enabled, albuminuria-first program using eGFR. Methods: This one-year cross-sectional intervention screened all patients receiving routine laboratory tests at a primary care center using a CDSS integrating prior labs, medical records, and guideline rules. Eligibility required patients age 60–85 (Group 1) or 18–59 with hypertension, diabetes, or cardiovascular disease (Group 2) . Eligible patients received urine albumin and eGFR testing with standard phlebotomy; abnormal findings triggered confirmatory tests. Outcomes were diagnostic yield, KDIGO risk stratification, referral patterns, and reagent costs. The CDSS surfaced prompts and pre-populated orders in the laboratory interface. Results: Of 7722 targets, 1892 (24.5%) were flagged (34.2% of Group 2, 7.9% of Group 1), and 1774 (93.8%) completed screening. We identified 104 new CKD cases (5.9%): 75% KDIGO moderate risk, 19% high, and 6% very high. Twenty patients (1.1%) met criteria for nephrology referral. Guideline-directed therapy was started or optimized in 90%, and 62.5% received anew CKD diagnosis code. Reagent costs averaged EUR 0.51 per person screened and EUR 11.14 per CKD case detected. Most cases were early-stage and manageable in primary care. Conclusions: CDSS-enabled opportunistic screening in primary care is feasible, acceptable, and low-cost. It identifies previously unrecognized CKD at modest expense, enabling early interventions that may slow progression and reduce cardiovascular events. Scaling with follow-up should assess long-term outcomes.  \nKeywords: chronic kidney disease; primary care; clinical decision support system; opportunistic screening; ","cbCaiaka6nj8MjWg","https://ap.wps.com/l/cbCaiaka6nj8MjWg","pdf",908526,12,"English","# Abstract\n## Background/Objectives\n## Methods\n## Results\n## Conclusions\n# 1. Introduction\n## CKD burden and asymptomatic progression\n## Opportunistic screening in routine workflows\n## Guideline-driven screening and the role of laboratories","[{\"question\":\"What was the main goal of the CDSS-enabled opportunistic screening program?\",\"answer\":\"To evaluate feasibility, diagnostic yield, clinical actions, and reagent costs of a CDSS-supported albuminuria-first program using eGFR in primary care.\"},{\"question\":\"How were participants selected and which tests were used?\",\"answer\":\"Eligibility included ages 60–85 (Group 1) or ages 18–59 with hypertension, diabetes, or cardiovascular disease (Group 2). Eligible patients received urine albumin and eGFR testing, with confirmatory tests triggered after abnormal results.\"},{\"question\":\"What outcomes were reported from the screening process?\",\"answer\":\"Diagnostic yield and KDIGO risk stratification, referral patterns to nephrology, rates of guideline-directed therapy initiation or optimization, and average reagent costs per screened person and per detected CKD case.\"}]","A Pilot Study of Opportunistic Chronic Kidney Disease Screening in Primary Care Using a Clinical Decision Support System | PDF",1790769626]