The prevalence of CKD increased with increasing age especially for VA patients ages 70 and older with 25%-32%.
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, by year and ckd risk factors (gender, race, diabetes mellitus, and hypertension) within each age group. Dialysis and transplant patients are excluded.
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 Health Care System, Ann Arbor, Michigan.
| Field | Data |
|---|
|
| Secondary (1) Variable | Age
as of January 1 of specified year |
|---|
| Denominator |
Patients aged 18 or older who have at least one outpatient
serum creatinine lab result within the stated fiscal year
|
|---|
| Definition of CKD | Stages 3-5 (eGFR < 60 ml/min/1.73 m²) excluding dialysis and transplant |
|---|
| 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". |
|---|
| 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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| 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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| Primary Data Source Indicator | Serum Creatinine Lab Result Value |
|---|
| Secondary (1) Indicator Method of Measurement | Date
of birth available for each outpatient visit. If multiple dates of birth are
reported, the most frequently reported date of birth was used. |
|---|
| Frequency of Measurement (Primary) | Multiple measurements within fiscal year, mean value taken |
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| Period Currently Available | 2005–2018 |
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| Regional or National? | National |
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| Demographic Group | Patients using the VA health system |
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| Numerator | Patients in denominator with creatinine testing meeting criteria for CKD stages 3-5 during fiscal year, excluding dialysis and transplant patients. |
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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 |
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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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