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Trends in Combined Testing of Serum Creatinine and Albuminuria among Commercially Insured Patients with Diagnosed CKD

The prevalence of patients receiving combined serum creatinine and albuminuria (urine albumin and urine creatine) tests in the same calendar year was 18.7% in 2007 and 32.3% in 2020. The frequency of combined testing tended to be higher in older patients. Prevalence of combined testing was approximately twice as high in patients with diabetes than without diabetes. Patients with hypertension were approximately twice as likely to receive the combined testing than those without hypertension. Patients with CKD stage 4 received the highest prevalence of both tests.

Data Source: Clinformatics Commercial

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Combined Testing of Serum Creatinine and Albuminuria among Commercially Insured Patients with Diagnosed CKD by Overall (%) Clinformatics Commercial
2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	2017	2018	2019	2020
18.7 (95% CI: 18.4-19.1)	21.0 (95% CI: 20.7-21.3)	24.1 (95% CI: 23.8-24.4)	25.4 (95% CI: 25.1-25.7)	26.5 (95% CI: 26.2-26.7)	27.6 (95% CI: 27.4-27.8)	29.1 (95% CI: 28.9-29.3)	26.2 (95% CI: 26.0-26.4)	33.4 (95% CI: 33.2-33.6)	33.8 (95% CI: 33.6-33.9)	32.5 (95% CI: 32.4-32.6)	33.6 (95% CI: 33.5-33.7)	34.7 (95% CI: 34.6-34.8)	32.3 (95% CI: 32.2-32.4)

Data includes CKD stages 1–5. Data are not adjusted.

Clinformatics data sets provide paid medical and prescription claims and enrollment information for participants in commercial insurance plans and Medicare Advantage plans. The sample was limited to those enrolled in their health plan for all 12 months of the calendar year. Chronic kidney disease (CKD) and diabetes are defined using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), or Tenth Revision (ICD-10-CM) diagnosis codes. Outpatient pharmacy records of prescriptions filled for patients were examined for drugs in the sodium-glucose cotransporter-2 (SGLT2) inhibitors class. For inclusion in analyses, beneficiaries had to be in the enrollment file. To define CKD, diabetes, or hypertension, at least one inpatient or two outpatient claims were used.

Field	Data
Description of Measure	Combined serum creatinine and UACR (urine albumin to creatinine ratio; or urine albumin or urine protein, and urine creatinine) among patients with CKD diagnosis in the prior calendar year in Clinformatics Commercial population.
Data Set	Clinformatics Commercial from Optum Clinformatics Data Mart Database (Optum Insight, Eden Prairie, MN).
Population	Privately insured patients aged ≥ 20 years with at least one inpatient or two outpatient claims during the calendar year.
Years Included	2007–2020.
Numerator	Patients aged ≥ 20 years who had both serum creatinine and either both urine creatinine and urine albumin or UACR testing claims within the specified calendar year.
Denominator	Patients aged ≥ 20 years enrolled in Clinformatics Commercial insurance and diagnosed with CKD.
Definition of CKD	ICD-9-CM and ICD-10-CM diagnosis codes shown below.
ICD-10-CM Codes for CKD	A18.11, A52.75, B52.0, C64.x, C68.9, D30.0x, D41.0x-D41.2x, D59.3, E08.2x, E09.2x, E10.2x, E10.65, E11.2x, E11.65, E13.2x, E74.8, I12.xx, I13.0, I13.1x, I13.2, K76.7, M10.3x, M32.14, M32.15, N01.x-N08.x, N13.1, N13.1x-N13.39, N14.x,N15.0, N15.8, N15.9, N16, N17.x, N18.1-N18.5, N18.8, N18.9, N19, N25.xx, N26.1, N26.9, O10.4xx, O12.xx, O26.83x, O90.89, Q61.02, Q61.1x-Q61.8, Q26.0-Q26.39, R94.4 (x and xx stand for all the codes within the main diagnosis).
ICD-9-CM Codes for CKD	016.0, 095.4, 189.0,189.1, 189.9, 236.91, 250.4, 250.41, 250.42, 250.43, 271.4, 274.10, 283.11, 403.xx, 404.xx, 405.01, 405.11, 440.1, 442.1, 447.3, 453.3, 573.4, 580.xx, 581.xx, 582.xx, 583.xx, 584.5, 585.x, 587.xx, 588.xx, 590.xx, 591, 592.x, 593.xx, 642.1, 646.2, 753.xx, 794.4.
Serum Creatinine and Albuminuria	The combined testing is defined as having at least one serum creatinine testing claim and at least one either both urine creatinine and urine protein/albumin or UACR testing claim within the specified calendar year. Lab testing was defined using Current Procedural Terminology (CPT®) codes as follows: Serum creatinine: 82565, 80047, 80048, 80050, 80053, 80069, 82610 Urine protein/albumin: 82042, 82043, 82044, 84156, 84166 Urine creatinine: 82570 UACR: 84156, 82570
Limitations of Indicator	As a measure of prevalence, the use of ICD-9-CM or ICD-10-CM diagnosis codes underestimate CKD prevalence.
Analytical Considerations	Consideration must be taken in comparisons based on diagnosis code-based definitions of CKD.