The prevalence (%) of VA patients with CKD by stages shows that the range of 60-89 is the highest, while dialysis and transplant were the lowest. The prevalence of stage 3 CKD increased from 9.7% to 13.9%.
Chart Explanation: This figure shows the level of kidney function classified into eGFR ranges/stages of CKD over time.
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.
| Field | Data |
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| Description of Measure | Prevalence of reduced eGFR and chronic kidney disease by stage. Note that this data has not been matched to Center for Medicare and Medicaid Studies (CMS) ESRD program data, so the dialysis and transplant categories underestimate the true prevalence of ESRD among veterans. |
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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 Data, using the MedSAS data files |
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| Health Care System Data | Yes |
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| Regional or National? | National |
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| Demographic Group | Patients in VA system |
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| Numerator | Patients in denominator with available serum creatinine results in the specified eGFR category ( 90+ and 60-89 ml/min/1.73 m²) or CKD stage (3-5, dialysis and transplant). |
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| Denominator | Patients aged >20 who have at least one outpatient visit or have at least one outpatient serum creatinine measurement |
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| Definition of CKD | ∙eGFR > 90 ml/min/1.73 m²
∙eGFR 60-89 ml/min/1.73 m²
∙Stage 3, eGFR 30-59 ml/min/1.73 m²
∙Stage 4, eGFR 15-29 ml/min/1.73 m²
∙Stage 5, <15 ml/min/1.73 m²
∙Stage 5D, on dialysis
∙Stage 5T, transplant |
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| Glomerular filtration rate | Estimated using the CKD-EPI equation: eGFR=141 X min(SCR/K,1)**A X max(SCR/K,1)**-1.209 X 0.993**Age X 1.018[if female] X 1.159[if black]
where SCR is serum creatinine in mg/dl, min is the minimum of SCR/K or 1, max is the maximum of SCR/K or 1, K=0.7 for female or K=0.9 for male,
A is -.329 for female and -.411 for male. 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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| Frequency of Measurement (Primary) | Multiple measurements per patient |
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| Period Currently Available | 2005–2018 |
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| Limitations of Indicator | Use of methods to standardize creatinine varies by facility.
Occurrence of CKD Stages 1 and 2 can not be calculated due to the low rate of urine albumin testing. |
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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