At-home urine self-testing using a smartphone

Around 1.2 million people have undiagnosed chronic kidney disease (CKD) in the UK and are at higher risk of hospitalisation and death.  

Early detection of CKD enables intervention at an early stage. This helps to:

• prevent or slow disease progression
• avoid cardiovascular disease (CVD) complications
• reduce the disease burden
• improve outcomes
• reduce long term population health costs

CVD PREVENT, NICE, QRISK, and the cardiac pathways improvement programme all support the increasing detection and treatment of patients with CKD. 

Situation

To identify CKD and CVD risk, clinical guidelines require patients with diabetes or hypertension to be tested for albumin in their urine.

According to the 2018 National Diabetes Audit, 66% of people with diabetes are tested. According to the 2017 CKD Audit, 30% of people with hypertension are tested. This is because the process was difficult and inconvenient.

Aspiration

The service would offer at-home albumin to creatinine ratio (ACR) testing using smartphones. This would be for:

• people with diabetes who haven't been tested before
• other at-risk patients

It would also improve early detection of CKD and reduce the burden of disease.

Solution

Healthy.io’s Minuteful Kidney early detection service is a cost-effective way to increase annual screening at-risk patients.

Using a home test kit and mobile app, the Healthy.io test is a semi-quantitative urine ACR which patients can use to test themselves.

Real-time results are fully integrated to the Electronic Medical Record (EMR). The results are available for a clinician to review and follow up.

Shifting testing to the home increases uptake while reducing workload in primary care.

The service includes:

• onboarding
• kit delivery
• measurement
• monitoring

The NHS partner provides Healthy.io with a list of eligible patients. The list is then securely imported into Healthy.io’s system.

Patients receive the kit in the post, and also get an information leaflet about the test.

They also receive a text message with a link to download the Minuteful Kidney app.

A call centre operated by Healthy.io help patients download the app if this is needed.

The app tells the patient how to perform the test step by step. At the end of the process, the user immerses the dipstick in urine, places it on a colour board and scans it using the app.

An algorithm analyses the scan and results are immediately pushed into the patients’ EMR.

The relevant medical staff can review the results in their EMR system, for example, EMIS or SystemOne.

Impact

• Since November 2020 the service has engaged with more than 144,000 patients across 16 integrated care systems. These patients had not completed a test in the last 12 months.
• The reaction from people taking the home tests has been positive. 96% of patients surveyed said they preferred home testing over taking a urine sample to their GP surgery.
• There are over 20,000 reviews on the Apple app store for Minuteful Kidney at 4.8 stars (out of 5). There are thousands of comments detailing positive patient experiences.
• Of those eligible for the service, over 74,000 patients have completed their test. This will help detect over 8,500 extra cases of CKD, reducing cases of end-stage renal disease and cardiovascular complications. 

According to the National CKD Audit, optimising the care for these additional CKD cases has the potential to avoid (every year):

• 595 cases of acute kidney injury
• 510 cardiovascular events
• 95 intensive care unit admissions
• 3,230 unplanned hospital admissions

Functionality

Healthy.io:

• is a cloud-based platform used by clinicians
• has a support call centre

The Minuteful Kidney app:

• is used by patients
• can be used on any iPhone or Android device and can be downloaded onto a carer’s phone
• has text messaging integration to support patients

Capabilities

The technology is equivalent to the laboratory-based ACR testing method and uses the same ACR dipstick.

By using this and combining it with computer visual and machine learning techniques, anyone can accurately test in any environment as long as they:

• have a smartphone
• are given a custom-developed testing kit

Scope

Minuteful Kidney can be used in any setting where the patient has access to a test kit and smartphone.

Digital equalities

The solution is designed to target patients who have not engaged with traditional clinic-based urine testing. It addresses the health inequality gap between those who have, and have not, received ACR screening.

Accessibility has been considered. The solution ensures that those who find it difficult to access their care through primary care services can access the service at home. This includes patients:

• with limited mobility or health issues
• who have work or caring responsibilities
• who live in a rural area

Age is not a barrier to using the Minuteful Kidney ACR kits. This is demonstrated by a 99% usability success across ages 18 to 80.

Health literacy has been considered and the chatbot provides verbal, video, and text instructions. These only require a reading age of 9.

Patients also have the opportunity to review and repeat instructions as required.

Access to a high-specification or personal smartphone is not a barrier.

Key quotes

“We have instituted this in our own practice and found that patients who have not previously supplied urine for ACR testing have done this simple test at home.

The whole process has been very straightforward and the results come through lab links in the same way as all our other results.

I would encourage practices not yet signed up to book an available appointment with Healthy.io to discuss getting involved."

Dr Stuart Logan, Clinical Director for Long Term Conditions in Buckinghamshire

Find out more

NICE clinical guideline CG182 chronic kidney disease in adults: assessment and management

NICE quality standard QS5 chronic kidney disease in adults

2018 National Diabetes Audit

2017 National CKD Audit

Key contact

Damian O’Boyle, Director of Operations, Healthy.io

damian@healthy.io

Dr Vaughan Lewis, Fellowship of the Royal College of Paediatrics and Child Health, South East Regional Medical Director, NHS England.

vaughanlewis@nhs.net