Can point-of-care testing improve early detection of chronic kidney disease in Africa?

Introduction

Chronic kidney disease (CKD) is a growing public health concern in Africa, where early detection remains challenging due to persistent gaps in access to diagnostic services and routine screening. A 2026 systematic review and meta-analysis estimated that CKD (stages 1-5) affects approximately 13.7% of adults across 19 African countries 1. Limited access to diagnostic services, the cost of laboratory investigations, and gaps in routine screening can delay the identification of kidney abnormalities, particularly among high-risk populations, including people living with hypertension, diabetes, and cardiovascular diseases 1–3. Evidence also indicates that risk-factor-based screening in primary care can support the early detection of CKD, reinforcing the importance of improving access to kidney health assessment in underserved settings 4.

This raises an important question: Could point-of-care testing (POCT) help bridge the gap between kidney disease risk and timely diagnosis in Africa?

What role could point-of-care testing play?

Point-of-care testing refers to any diagnostic test performed near the patient, rather than exclusively in centralised laboratories 5,6. It is commonly referred to as “bedside testing” 7. By providing results closer to the point of care, POCT may reduce delays associated with specimen transportation and result reporting and support more timely clinical decisions.

For kidney health, two important areas of assessment are:

• Blood creatinine:

  Used to estimate kidney filtration function through a calculated estimated glomerular filtration rate (eGFR).

• Urine albumin:

  Helps identify kidney damage. Measuring the urine albumin-to-creatinine ratio (ACR) is particularly useful for assessing albuminuria.

Evidence suggests that POCT can support CKD screening by enabling creatinine and urine albumin measurements in community and primary healthcare settings, particularly where access to conventional laboratory services is limited 8–10. Although selected POCT devices have demonstrated promising diagnostic performance, accuracy varies across technologies, with some exhibiting measurement bias and reduced sensitivity.

The 2024 Kidney Disease: Improving Global Outcomes (KDIGO) guideline highlights the potential role of point-of-care testing (POCT) in CKD screening, particularly for measuring creatinine, urine albumin or urine protein in settings with limited access to laboratory services or where decentralised testing can facilitate earlier detection, reduce delays in obtaining test results, and support timely clinical decision-making and referral 9. The World Health Organization has also included point-of-care creatinine testing in its Model List of Essential In Vitro Diagnostics for use in settings such as community outreach and primary healthcare facilities without laboratories 11.

These recommendations provide a strong rationale for exploring decentralised kidney health testing in Africa. However, the value of POCT extends beyond the availability of a rapid test; it depends on whether the test can be integrated into a functioning pathway for screening, confirmation, referral, and treatment.

Five considerations for implementing kidney health POCT in Africa

1. Diagnostic performance and clinical utility

Not all POCT devices perform equally, and the convenience of rapid testing should not be confused with diagnostic accuracy. Devices must be evaluated against appropriate laboratory algorithms and standard guidelines, such as the World Health Organization’s (WHO) REASSURED criteria (Real-time connectivity, Ease of specimen collection, Affordability, Sensitivity, Specificity, User-friendliness, Rapidity and robustness, Equipment-free, and Deliverable to end-users), with attention to analytical performance, clinical sensitivity and specificity, and the potential consequences of false-positive and false-negative results 12–14. For example, if a point-of-care creatinine diagnostic underestimates a patient’s serum creatinine concentration, the calculated estimated glomerular filtration rate (eGFR) may be falsely reassuring, potentially resulting in missed kidney dysfunction and delayed referral. Conversely, overestimation of creatinine may produce an artificially low eGFR, leading to unnecessary referrals, additional investigations, unnecessary costs, and patient anxiety. Similarly, a urine albumin screening device that produces a false-negative result may fail to identify albuminuria in a patient with diabetes or hypertension, whereas a false-positive result may lead to unnecessary follow-up investigations. These highlight that the clinical value of POCTs depends not only on the speed of testing but also on the accuracy of results and the extent to which measurement errors may influence clinical decisions.

For creatinine screening, the results are recommended to be used to estimate the glomerular filtration rate (eGFR) using an appropriate equation, with abnormal findings prompting further clinical assessment and confirmatory testing where indicated 9. For urine albumin screening, quantitative measurement and calculation of the urine albumin-to-creatinine ratio (ACR) provide more clinically useful information than a simple positive or negative result 9. However, a positive result from an initial qualitative screening test should prompt quantitative assessment to determine the extent of albuminuria. Where initial screening suggests albuminuria or reduced kidney function, confirmatory testing using appropriate laboratory methods and repeat assessment, where indicated, are essential before establishing a diagnosis of chronic kidney disease (CKD). Quality assurance, staff training, device maintenance, and external quality assessment are also crucial to ensuring the reliability of POCT results and supporting appropriate clinical decision-making 15,16.

2. Affordability and equitable access

The potential of POCT lies partly in its ability to bring diagnostic services closer to people who face geographical, financial, or health-system barriers to laboratory testing. In rural and hard-to-reach communities, and resource-constrained primary healthcare facilities, decentralised testing could reduce the need for some patients to travel to higher-level facilities solely to obtain initial kidney function measurements. However, an abnormal POCT result requires further laboratory investigations to confirm kidney abnormalities, assess their severity, and guide clinical management 9. If patients cannot afford these additional tests, the benefits of initial screening may be limited, potentially leaving suspected cases undiagnosed or delaying appropriate care.

The cost-effectiveness of implementing POCT for kidney disease should therefore be evaluated by considering the costs of equipment, consumables, staff training, quality assurance, maintenance, confirmatory testing, and follow-up care 17. Affordability should be assessed across the entire diagnostic pathway, not simply in terms of the purchase price of a POCT device. This includes determining whether patients can afford confirmatory investigations and subsequent care, and whether health systems can sustainably finance these services. Integrating POCT into existing primary healthcare services, alongside appropriate financing and referral arrangements, may help minimise out-of-pocket expenditure and ensure that abnormal screening results lead to timely diagnosis and care

3. Integration of POCT into primary healthcare through task sharing, follow-up and referral pathways

A positive screening result is only the beginning of the diagnostic process. Patients need access to clinical assessment, confirmatory investigations, appropriate referral, and treatment. This is particularly important because CKD is defined by abnormalities of kidney structure or function that persist for at least three months 1. A single abnormal creatinine, eGFR, or urine albumin result does not automatically establish chronic kidney disease; the finding may reflect an acute or temporary abnormality 9. Consequently, implementation strategies should clearly define who will be screened, how abnormal results will be communicated, when testing should be repeated, and how patients will be linked to appropriate care. Without these arrangements, decentralised testing may identify abnormalities without ensuring that patients receive the care they need.

Many hard-to-reach communities across Africa face limited access to conventional laboratory services because of geographical barriers, inadequate diagnostic infrastructure, workforce shortages, and travel costs 18,19. POCT could improve access to kidney health assessment within primary healthcare and chronic disease management services, particularly for people living with hypertension and diabetes. Task shifting and empowering community health workers (CHWs) could further extend these services by equipping appropriately trained personnel to support risk assessment, conduct approved screening tests where permitted, provide health education, and facilitate referral and follow-up. Such an approach could bring kidney health screening closer to underserved populations while reducing pressure on overstretched health professionals. However, implementation requires structured training, clear scopes of practice, supervision, quality assurance, and reliable referral pathways 9.

Patients with abnormal screening results should receive counselling, clinical assessment, and appropriate confirmatory testing, with urgent referral for markedly reduced eGFR, significant albuminuria, or other concerning findings. In settings where laboratories are distant, CHWs could help coordinate specimen transportation, remind patients about follow-up appointments, track referrals, and communicate results in collaboration with primary healthcare teams. They should not independently diagnose CKD or make clinical decisions beyond their training and authorised scope of practice. Importantly, a single abnormal POCT result does not establish CKD, which generally requires evidence of kidney abnormalities persisting for at least three months 1,9. Integrating task-shared POCT into primary healthcare, supported by affordable confirmatory testing and clear referral protocols, could help translate improved screening access into timely diagnosis and appropriate care.

4. Multimorbidity and integrated screening

Kidney health should not be considered in isolation from other chronic conditions. People living with diabetes, hypertension, HIV, and other long-term conditions may require assessment for kidney disease as part of their ongoing care. Integrating kidney health assessment into existing primary healthcare services could create opportunities to identify multiple conditions through coordinated screening and follow-up. Such an approach may reduce fragmented care and make better use of existing healthcare resources. However, integrated screening models must be evaluated to establish whether they improve detection, acceptability, linkage to care, and health outcomes without placing excessive demands on patients and healthcare workers 20.

5. Home-based testing, self-testing and decentralised monitoring

Home-based kidney health testing and monitoring may involve two distinct approaches: patient-performed self-testing, in which individuals conduct tests and interpret results at home, and healthcare worker-led testing during home visits, in which trained personnel perform tests and support result interpretation, counselling, and referral. Both approaches could extend kidney health assessment beyond conventional healthcare facilities, particularly for people at increased risk of chronic kidney disease (CKD), including those living with diabetes, hypertension, or other chronic conditions 8. However, their suitability depends on the intended users, the type of test, and the clinical purpose. Technologies intended for self-testing require validation for use by non-professionals, with clear instructions on sample collection, test performance, result interpretation, and when to seek professional care 21. Healthcare worker-led testing, meanwhile, requires appropriate training, supervision, and quality assurance to ensure reliable testing and referral 21.

The clinical value of both approaches also depends on affordability, user literacy, quality assurance, data privacy, and access to confirmatory testing and follow-up care 21. These considerations are particularly important in resource-constrained settings, where identifying a potential kidney abnormality may not lead to timely clinical assessment or treatment. Healthcare worker-led home visits may help address some barriers to self-testing by providing assistance with test procedures, explaining results, and facilitating referrals; however, this approach depends on workforce availability and sustainable implementation. Furthermore, because CKD requires evidence of kidney abnormalities persisting for at least three months, a single abnormal home-test result cannot independently establish a diagnosis 9. Home-based kidney testing, either patient-led or trained personnel-led should therefore be evaluated as a potential complement to established diagnostic and clinical pathways, rather than a replacement for professional assessment, confirmatory testing, and ongoing care.

Moving from promising technologies to effective implementation

From a health systems and implementation science perspective, the key question is whether POCT for CKD can be implemented reliably, affordably, equitably, and sustainably in African healthcare settings. Future research should assess the diagnostic accuracy and clinical utility of kidney function and urine albumin tests in African populations, their cost-effectiveness compared with conventional laboratory-based pathways, and their acceptability among patients and healthcare workers. It should also examine the feasibility of integrating CKD screening into primary healthcare and multimorbidity programs, including home-based monitoring where appropriate, and evaluate whether referral, confirmatory testing, and follow-up systems ensure that people with abnormal results receive timely care. Addressing procurement, supply chains, staff competencies, quality assurance, and health financing will be essential to support sustainable implementation and equitable scale-up of CKD POCT, particularly in underserved communities in Africa.

Conclusion

POCT has the potential to support earlier identification of kidney abnormalities in Africa by bringing selected diagnostic services closer to patients and primary healthcare facilities, particularly in underserved communities where access to conventional laboratory services is limited. However, its contribution to CKD screening will depend on diagnostic accuracy, affordability, quality assurance, confirmatory testing, effective referral pathways, and integration into routine healthcare.

Moving beyond the availability of testing technologies towards reliable diagnostic pathways is essential to ensure that people with abnormal screening results receive appropriate clinical assessment, follow-up, and timely care. Greater research, implementation, and policy attention is therefore needed to establish how kidney health POCT can be integrated sustainably into primary healthcare and multimorbidity screening programs across African settings.

Dr Evans Duah is the Head of Technology and Innovation at Kidney Research initiative Ghana. He is a Medical Laboratory Scientist and Public Health researcher. He specialises in point-of-care diagnostics, implementation science, and health systems research. His work focuses on improving access to accurate, affordable, and equitable diagnostic services, particularly in primary healthcare and resource-constrained settings across Africa.

https://www.linkedin.com/in/evans-duah-75107649