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Indicator Details: Percentage of Patients with Urine Albumin Laboratory Results
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The fraction of veterans with urine albumin laboratory results is increasing over time in each age group, though urine albumin testing is done less frequently than serum creatinine testing. The percentage with urine albumin results increased from 1%–7% for those 20–29 years; 3%–9% for those 30–39 years; 6%–16% for those 40–49 years; 11%–22% for those 50–59 years; 12%–27% for those 60–69 years; and 10%–25% for those 70 years and older.

Chart Explanation: These charts show percentage of patients with urine albumin laboratory results by age and year of observation or CKD risk factor (gender, race/ethnicity, diabetes or hypertension) status.
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)

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.

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 MeasureUrine Protein Testing Practices
Data SourceVA
Type of Data SourceAdministrative Data
Data SetVA National Data, using the MedSAS data files
Health Care System DataYes
Regional or National?National
Demographic GroupPatients in VA health system
NumeratorPatients in denominator who had a laboratory result for urine albumin or urine albumin:creatinine ratio.
DenominatorPatients aged >20 who have at least one outpatient visit, within specified age group.
Primary Data Source IndicatorUrine microalbumin or microalbumin:creatinine ratio test results
Primary Indicator Method of MeasurementLaboratory
Secondary (1) VariableAge = (Date of Visit - Date of Birth)/365.25
Secondary (1) Indicator Method of MeasurementOutpatient Visit
Secondary (2) VariableHypertension status determined by ICD-9-CM code (401, 402, 403, 404, 405 ) and/or prescribed antihypertensive medication (outpatient only).
Secondary (2) Indicator Method of MeasurementOutpatient visit and pharmacy data
Frequency of Measurement (Primary)Multiple measurements per patient
Period Currently Available2005–2018
Limitations of IndicatorThe VA health care system is a closed system – most laboratory requests are processed internally, and payment is generally not dependent upon the presence of a CPT code. Hence procedural codes and serum creatinine lab results do not always correlate.

Suggested Citation:
Centers for Disease Control and Prevention. Chronic Kidney Disease Surveillance System—United States.
website. http://www.cdc.gov/ckd