Under age 40, the prevalence of CKD Stages 3-5 (eGFR<60) is similar for diabetics and non-diabetics. For ages greater than 40, diabetics have roughly twice the prevalence of CKD compared to non-diabetics.
Chart Explanation: These charts show the percentage of patients with serum creatinine lab results yielding an estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73m2, using the MDRD equation, which is stages 3-5 of chronic kidney disease, within each age group and by whether or not they have diabetes mellitus (determined by diagnosis, medication use and lab tests, if available). Dialysis and transplant patients are excluded. Use the radial buttons to see data for different years.
The Veteran’s Affairs (VA) data presented are from a national sample of health care visits to the VA Health System by eligible United States veterans. During any given year, roughly 70% of the outpatient population receives at least one serum creatinine test. While the demographics of VA Health System users are distinct from the general US population, the VA data allow a snapshot of clinical practices across the nation.
National VA data were examined. Within each VISN (Veterans Integrated Service Network), a 5% random sample of patients was extracted from the national VA data repository each fiscal year (FY) from FY2005 to FY2009. Starting in FY2010 and continuing in future years, analyses were performed on the entire patient population (100% sample). 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 four-variable MDRD study formula, excluding dialysis and transplant patients. Stages
3-5 correspond to eGFR < 60 ml/min/1.73m2.
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.
| Field | Data |
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| Description of Measure | Prevalence of stages 3-5 CKD, eGFR<60 ml/min/1.73m2 using the MDRD equation and excluding ESRD patients, by age and diabetes mellitus status |
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| Data Source | VA |
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| Type of Data Source | Administrative Data |
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| Data Set | VA National 5% Sample (FY05-FY09) and 100% (FY10-present) |
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| Health Care System Data | Yes |
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| Regional or National? | National |
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| Demographic Group | Patients using the VA health care system |
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| Numerator | Patients in denominator with creatinine testing meeting criteria for CKD stages 3-5 during the fiscal year, excluding dialysis and transplant patients |
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| Denominator | Patients
aged 18 or older who have at least one outpatient serum creatinine lab result
within the stated fiscal year |
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| Definition of CKD | Stages 3-5 (eGFR < 60 ml/min/1.73 m²) excluding dialysis and transplant |
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| Glomerular filtration rate | Estimated using the four-variable MDRD study equation: eGFR=186 × [(serum creatinine in mg/dl)**1.154] × age**-0.203 × (0.742 if female) × (1.210 if African-American). Missing race/ethnicity was coded as white. ** signifies "raised to the power of". |
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| Primary Data Source Indicator | Serum Creatinine Lab Result Value |
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| 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. |
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| Secondary (1) Variable | Age
as of January 1 of specified year |
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| Secondary (1) Indicator Method of Measurement | Date of birth is available for each outpatient visit. If multiple dates of birth are reported, the most frequently reported date of birth was used. |
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| Secondary (2) Variable | Diabetes status determined by inpatient or outpatient diagnosis (ICD-9-CM code), outpatient lab test results for hemoglobin A1c (6.5 or higher) or glucose (200 or higher) and/or the filling of an outpatient prescription for diabetes medication through the VA pharmacy. |
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| Secondary (2) Indicator Method of Measurement | Inpatient and outpatient visit diagnoses, outpatient laboratory results, and outpatient prescription records |
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| Frequency of Measurement (Primary) | Multiple measurements per patient, mean value taken |
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| Period Currently Available | 2005–2012 |
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| Limitations of Indicator | Use
of methods to standardize creatinine varies by facility. Use of estimating
equation for glomerular filtration rate rather than direct measurement
introduces imprecision. |
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References and Sources:
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Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999;130(6):461-70.
http://www.ncbi.nlm.nih.gov/pubmed/10075613