The incidence of CKD was higher in males, older individuals, non-Hispanic whites, those with diabetes and those with hypertension. Incidence among Native Hawaiians and Pacific Islanders was similar to non-Hispanic whites, while other race and ethnic groups were lower.
Chart Explanation: This set of charts shows the incidence rate for each stage of kidney disease. The first set of bars shows the rate for CKD Stages 3-5 and the others show the rates for each stage in order of decreasing kidney function. Dialysis and transplant rates are likely underestimates, as the data only identify procedures performed within the VHA system or noted by diagnosis code.
For the charts by age, gender, race/ethnicity, diabetes, and hypertension, the each bar shows the incidence rate for that CKD stage among each level of the stratification variable (for example, the incidence rate of Stages 3-5 for men and for women).
The Veteran’s Affairs (VA) data presented are from a national sample of health care visits to the VA Health System by eligible U. S. veterans. During any given year, ~ 70% of the outpatient population receives a serum creatinine test. While the demographics of VA Health System users are distinct from the general U.S. population, the VA data allow a ‘snapshot’ of clinical practices across the nation.
National VA data were examined for veterans with at least one outpatient visit during the federal fiscal year. To estimate prevalence of CKD, outpatient serum creatinine laboratory results (averaged if a patient had more than one test during the fiscal year) were used to calculate an estimated glomerular filtration rate (eGFR) for each patient using the CKD-EPI equation, excluding dialysis and transplant patients. Estimated GFR (kidney function) was classified into five CKD categories (eGFR =90, eGFR 60-89, stage 3=eGFR 30-59, stage 4=eGFR 15 to 29, and stage 5 without dialysis=eGFR<15 ml/min/1.73 m² and “eGFR Unmeasured” for those patients without serum creatinine testing. Inpatient serum creatinine data were not used as they would be affected by the presence of acute illnesses. Due to the infrequency of testing, albuminuria was not included in the definition of CKD. Dialysis patients were defined by clinic stop-codes (602-611), outpatient procedure codes for dialysis (CPT4: 90921 and 90925), outpatient diagnosis codes (ICD-9-CM: 585.6, V56, V45.1 and E87.91 and ICD-10-CM: N186, Y841, Z4931, Z4901, Z4902, Z4931, Z4932, and Z4933) to indicate dialysis. Kidney transplant patients were identified by inpatient and outpatient ICD-9-CM diagnosis code V420, 99681, ICD-10 CM diagnosis code T86X, Z4822 and Z940, and inpatient procedure and surgery codes (55.69)
This material is the result of work supported with resources and the use of facilities at the Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.
|Description of Measure ||Incidence of individual CKD stages/eGFR categories using eGFR and additional ascertainment for dialysis and transplant.|
|Data Source ||VA|
|Type of Data Source ||Administrative Data|
|Data Set||VA National Data, using the MedSAS data files|
|Health Care System Data||Yes|
|Regional or National? ||National|
|Demographic Group ||Patients in VA system|
|Numerator ||Patients in denominator with creatinine testing in the current year meeting criteria for the specified CKD stage/eGFR category.|
|Denominator ||Patients aged >20 who have at least one outpatient visit in the current year, that had at least one outpatient visit the year before with either (a) normal eGFR, (b) an earlier stage of CKD/reduced eGFR than the specified stage or (c) no serum creatinine measurement.|
|Primary Data Source Indicator ||Serum Creatinine Lab Result Value|
|Primary Indicator Method of Measurement ||Laboratory: A valid serum creatinine value was defined as 0.3-15.0 mg/dl. Any values outside of this range were set to “missing.” No more than 1% of serum creatinine values in each cohort were outside of this range.|
|Secondary (1) Variable||Age = (Date of Visit - Date of Birth)/365.25|
|Secondary (1) Variable Method of Measurement||Outpatient Visit|
|Secondary (2) Variable||Sex: Gender|
|Secondary (2) Variable Method of Measurement||Outpatient Visit|
|Secondary (3) Variable||Race/ethnicity|
|Secondary (3) Variable Method of Measurement||Outpatient and/or inpatient visits|
|Secondary (4) Variable||Diabetes status determined by ICD-9-CM or ICD-10-CM code, hemoglobin A1c lab (6.5+), glucose lab (200+) and/or prescribed medication (outpatient only).|
|Secondary (4) Variable Method of Measurement||Outpatient visit, Inpatient visit, laboratory results and Pharmacy data for diabetes medication|
|Secondary (5) Variable||Hypertension status determined by ICD-9-CM or ICD-10-CM or prescribed medication (outpatient only).|
|Secondary (5) Variable Method of Measurement||Outpatient visit and pharmacy data|
|Frequency of Measurement (Primary) ||Multiple measurements per patient|
|Period Currently Available||2018|
|Limitations of Indicator||Determination of incidence is directly related to frequency of testing (both serum creatinine and urinary albumin).
The earlier categories of eGFR (≥90 and 60-89 ml/min/1.73 m² ) are not definitively classifiable into CKD stages 1 and 2 because of absence of albuminuria information in the vast majority of these patients.|