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Home > Outcomes > Mortality in CKD in the Healthcare System > All-Cause Mortality by eGFR, Including Dialysis and Transplant Patients

All-Cause Mortality by eGFR, Including Dialysis and Transplant Patients

All-Cause Mortality by eGFR, Including Dialysis and Transplant Patients

The rate of mortality increases with lower eGFR. Patients on dialysis have the highest mortality rates over time, while those in earlier stages of CKD had lower rates of mortality. Rates have remained relatively unchanged from 2006 through 2022.

Data Source: NATIONAL VA
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CKD stage determined by laboratory values, while dialysis and transplantation were defined by ICD-9 & ICD-10 diagnosis or CPT codes. All categories are mutually exclusive. Data are not adjusted.

VHA is America’s largest integrated health care system, providing care at 171 medical centers and 1,113 outpatient sites. VHA serves over 9 million enrolled Veterans each year. National VHA data were examined for Veterans with at least one outpatient visit during the federal fiscal year (October 1 to September 30). Medical conditions were defined by ICD-9-CM and ICD-10-CM diagnosis codes on at least one outpatient claim.

FieldData
Description of Measure

All-cause mortality (per 1,000 patient-years).

Data Set

VHA national data, using the MedSAS data, MCA prescription data, and the CDW LabChem files..

Population

Patients in VHA, including fee-based patients (i.e., Veterans who received care outside of VHA that was paid by VHA).

Years Included

2006–2022.

Numerator

Patients aged ≥ 18 years who died during the fiscal year.

Denominator

Patients aged ≥ 18 years who had at least one outpatient visit.

Date of Death

The date of death is from the VHA Vital Status master file. This file contains deaths ascertained from family, VHA hospitals, the VHA National Cemetery Administration, the Social Security Death Master File, and the Centers for Medicare & Medicaid Services (CMS). 

Definition of CKD

CKD is defined based on estimated glomerular filtration rate (eGFR) categories: eGFR ≥ 90 ml/min/1.73 m², eGFR 60–89 ml/min/1.73 m², eGFR 30–59 ml/min/1.73 m², 15–29 ml/min/1.73 m², < 15 ml/min/1.73 m², dialysis or transplant.

Estimated glomerular filtration rate (eGFR)

Based on the CKD-EPI (2021) equation for calibrated creatinine: eGFR=142 x [min(serum creatinine in mg/dL) /κ, 1)]**α x [max(serum creatinine/κ, 1)]**-1.20 x 0.9938**age x (1.012 if female).

κ = 0.7 if female and 0.9 if male
α = -0.241 if female and -0.302 if male
** = raise to the power

Serum Creatinine

Laboratory measurements taken during outpatient appointments.

Dialysis & Transplant

Dialysis and transplantation were determined from ICD-9 & ICD-10 codes, as follows:

Dialysis:  ICD-9, V56.x, E879.1x, 585.6; ICD10, N18.6, Y84.1, V56, Z49.01, Z49.02, Z49.31, Z49.32, Z91.15, Z99.2; outpatient CPT codes, 90918, 90919, 90921, 90922, 90923, 90925, 90935, 90937, 90940, 90945, 90947, 90951, 90952-90967, 90997, 90999 and outpatient dialysis clinic (600-611) visits.

x and xx stand for all the codes within the main diagnosis.

Transplantation: ICD-9, V42.0, 996.81; ICD10, T86.1x, Z48.2x, Z49.xx and if the transplant occurred within VA (DRG 302,512 before FY17, 008 652 after FY17). Procedure/Surgery codes are ICD-9,556.9, ICD10, OTYO1, and OTYO2.

Limitations of Indicator

Deaths may occur that are outside the Vital Status file and are not captured in the numerator.

Analytical Considerations

Not all Veterans use the VHA Health System. These data were not linked to the CMS ESKD program data, so the dialysis and transplant categories may underestimate the true prevalence of ESRD among Veterans. It is likely that some Veterans with eGFR <15 ml/min/1.73m² in stage 5 receive dialysis outside the VHA Health System.