Home > Awareness > Provider Awareness of CKD > Service Members and their Dependents with CKD Stages 3–5 who have a Diagnosis Code for CKD in the Military Health System

Service Members and Their Dependents with CKD Stages 3–5 Who Have a Diagnosis Code for CKD in the Military Health System

For MHS beneficiaries with CKD stages 3–5 based on eGFR, the prevalence of those who also had an ICD-9 diagnosis code for CKD was around 37–39% in 2012–2015. After conversion to ICD-10 in 2016, the prevalence was around 32–33% in 2016–2019. The crude percent with a diagnosis code was higher in men, adults aged 18−59 years, and those with CKD stage 4−5 compared with the corresponding counterparts.

Data Source: DoD-MHS

To view the prevalence of adults with CKD stages 3–5 who have a diagnosis code for CKD by risk categories, select from the drop-down menu below. Risk categories include: Overall, Age Category, Sex, Race/Ethnicity, and CKD Stage.

Aware of CKD (%), Overall

Select Risk Category

View as table

Download: PPT

Crude Age-Standardized

Population in poverty by county

Select a state from the dropdown below

Sort By:

+ View Data Table

Percentage of Service Members with CKD Stages 3-5 Who Have a Diagnosis Code for CKD in the Military Health System by Overall (%) Department of Defense Military Health System
2009	2010	2011	2012	2013	2014	2015	2016	2017	2018	2019
31.9	33.6	36.7	37.3	38.2	38.6	39.7	32.1	32.5	32.7	32.5

Percentage of Service Members with CKD Stages 3-5 Who Have a Diagnosis Code for CKD in the Military Health System by Overall (%) Department of Defense Military Health System
2009	2010	2011	2012	2013	2014	2015	2016	2017	2018	2019
29.7	31.7	34.7	35.3	36.5	36.6	37.8	30.3	30.9	30.4	28.9

The estimated glomerular filtration rate (eGFR in ml/min/1.73²) was calculated from serum creatinine using the 2021 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation which does not include race as a variable. End-stage kidney disease (ESKD) adults (dialysis and transplant) who were identified by ICD-9 or ICD-10 codes were excluded from eGFR calculations. Estimates were standardized to the 2010 U.S. Census population.

The US Department of Defense Military Health System (MHS) provides comprehensive primary and specialty care for more than 9.6 million active-duty personnel and military retirees and their families worldwide. The MHS Data Repository (MDR) is the administrative claims database for all care received through MHS, including direct care received in military treatment facilities and purchased care received in civilian treatment facilities. The MDR does not capture health care delivery in combat zones or care received in the VHA system. All patients were in the TRICARE Prime managed care option. Data are from both the direct care (military facilities) and private care (private facilities through TRICARE coverage) systems.

De-identified patient data were obtained from the MHS data repository. Data contain both the estimated glomerular filtration rate (eGFR) definition of chronic kidney disease (CKD) and claims-based CKD defined by using ICD-9-CM and ICD-10-CM codes diagnosis codes with at least one inpatient or two outpatient CKD diagnoses. To be included in analyses, service members and their dependents had to have at least one inpatient or outpatient record during the fiscal year (October 1 to September 30). Data cells with 10 or fewer patients were suppressed.

Disclaimer: The views expressed are those of the authors and do not reflect the official policy of the Uniformed Services University, Departments of Army/Navy/Air Force, Department of Defense, Centers for Disease Control and Prevention, Department of Health and Human Services, or US government.

Field	Data
Description of Measure	Percentages of Department of Defense Military Health System beneficiaries with eGFR < 60 mL/min/1.73 m² and ICD-9 or ICD-10 codes indicating a CKD diagnosis.
Data Set	U.S. Department of Defense Military Health System (MHS) Data Repository (MDR). MDR source files: CAPER (direct care outpatient claims), SIDR (direct care inpatient claims), TED-NI (private care outpatient claims), TED-I Header (private care inpatient claims), CHEMISTRY (laboratory data), and VM6BEN (demographic information from the Defense Enrollment Eligibility Reporting System).
Population	Beneficiaries of age ≥ 18 years enrolled in the TRICARE Prime or Plus managed care options.
Years Included	Fiscal years 2009-2019 (October 1, 2008 to September 30, 2019).
Numerator	Population in denominator that also had ≥ 1 inpatient or ≥ 2 outpatient encounters with matching ICD-9 or ICD-10 codes for CKD during the fiscal year. Data cells with less than 11 counts were suppressed.
Denominator	Population with CKD by eGFR as described in the definition of CKD. Data cells with less than 11 counts were suppressed.
Definition of CKD	CKD was defined by an average estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m² over the fiscal year. Serum creatinine measured during inpatient encounters were excluded. Outlier values (serum creatinine ≤ 0 mg/dL or > 25 mg/dL, or eGFR > 200 ml/min/1.73 m²) were excluded. Beneficiaries with diagnosis of dialysis or transplant were excluded from eGFR categorization.
Estimated glomerular filtration rate (eGFR)	Based on the CKD-EPI (2021) equation for calibrated creatinine: eGFR=142 x [min(serum creatinine in mg/dL) /κ, 1)]α x [max(serum creatinine/κ, 1)]-1.20 x 0.9938age x (1.012 if female). κ = 0.7 if female and 0.9 if male α = -0.241 if female and -0.302 if male = raise to the power
ICD-9 and ICD-10 Codes	CKD (ICD-9): 16, 95.4, 189, 189.1, 189.9, 236.91, 250.4, 250.41, 250.42, 250.43, 271.4, 274.1, 283.11, 403, 403.01, 403.1, 403.11, 403.9, 403.91, 404, 404.01, 404.02, 404.03, 404.1, 404.11, 404.12, 404.13, 404.9, 404.91, 404.92, 404.93, 405.01, 440.1, 442.1, 447.3, 453.3, 572.4, 580, 580.4, 580.81, 580.89, 580.9, 581, 581.1, 581.2, 581.3, 581.81, 581.89, 581.9, 582, 582.1, 582.2, 582.4, 582.81, 582.89, 582.9, 583, 583.1, 583.2, 583.4, 583.6, 583.7, 583.81, 583.89, 583.9, 584.5, 584.6, 584.7, 584.8, 584.9, 585.x, 586, 587, 588, 588.1, 588.81, 588.89, 588.9, 589, 590, 590.8, 591, 593.1, 593.3, 593.4, 593.5, 593.6, 593.7, 593.81, 593.89, 593.9, 642.1, 646.2, 753, 753.1, 753.11, 753.12, 753.13, 753.14, 753.15, 753.16, 753.17, 753.19, 753.2, 753.21, 753.22, 753.23, 753.29, 753.3, 753.4, 753.5, 753.6, 753.7, 753.8, 753.9, 791, 791.1, 791.2, 791.3, 791.4, 791.5, 791.6, 791.7, 791.9, 794.4, 585.6, 996.81, V42.0, V45.1, V56.0, V56.1, V56.2, V56.3, V56.31, V56.32, V56.8, E879.1. CKD (ICD-10): A18.11, B58.83, C64.1, C64.2, C64.9, C65.1, C65.2, C65.9, C66.1, C66.2, C66.9, C79.00, C79.01, C79.02, C7A.093, D30.00, D30.01, D30.02, D30.10, D30.11, D30.12, D30.20, D30.21, D30.22, D3A.093, D41.00, D41.01, D41.02, D41.10, D41.11, D41.12, D41.20, D41.21, D41.22, D49.511, D49.512, D49.519, D51.1, D86.84, E08.21, E08.22, E08.29, E09.21, E09.22, E09.29, E10.21, E10.22, E10.29, E11.21, E11.22, E11.29, E13.21, E13.22, E13.29, E26.81, E72.00, E72.01, E72.02, E72.03, E72.04, E72.09, E72.53, E83.31, E87.21, E87.22, I12.0, I12.9, I13.0, I13.10, I13.11, I13.2, I15.0, I15.1, I72.2, I75.81, I77.73, I77.82, I82.3, M32.14, M32.15, M35.04, M35.0A, N02.0, N02.1, N02.2, N02.3, N02.4, N02.5, N02.6, N02.7, N02.8, N02.9, N02.A, N03.0, N03.1, N03.2, N03.3, N03.4, N03.5, N03.6, N03.7, N03.8, N03.9, N03.A, N04.0, N04.1, N04.2, N04.3, N04.4, N04.5, N04.6, N04.7, N04.8, N04.9, N04.A, N05.0, N05.1, N05.2, N05.3, N05.4, N05.5, N05.6, N05.7, N05.8, N05.9, N05.A, N06.0, N06.1, N06.2, N06.3, N06.4, N06.5, N06.6, N06.7, N06.8, N06.9, N06.A, N07.0, N07.1, N07.2, N07.3, N07.4, N07.5, N07.6, N07.7, N07.8, N07.9, N07.A, N08, N11.0, N11.1, N11.8, N11.9, N12., N13.0, N13.1, N13.2, N13.30, N13.39, N13.4, N13.5, N13.6, N13.70, N13.71, N13.721, N13.722, N13.729, N13.731, N13.732, N13.739, N13.8, N13.9, N14.0, N14.11, N14.19, N14.2, N14.3, N14.4, N15.0, N15.1, N15.8, N15.9, N16, N18.1, N18.2, N18.30, N18.31, N18.32, N18.4, N18.5, N18.6, N18.9, N21.0, N21.1, N21.8, N21.9, N22, N23, N25.1, N25.89, N25.9, N26.1, N26.2, N26.9, N27.0, N27.1, N27.9, N28.0, N28.1, N28.81, N28.82, N28.83, N28.84, N28.85, N28.86, N28.89, N28.9, N29, O10.211, O10.212, O10.213, O10.219, O10.22, O10.23, O10.311, O10.312, O10.313, O10.319, O10.32, O10.33, O26.831, O26.832, O26.833, O26.839, P96.0, Q27.1, Q27.2, Q60.0, Q60.1, Q60.2, Q60.3, Q60.4, Q60.5, Q60.6, Q61.00, Q61.01, Q61.02, Q61.11, Q61.19, Q61.2, Q61.3, Q61.4, Q61.5, Q61.8, Q61.9, Q62.0, Q62.10, Q62.11, Q62.12, Q62.2, Q62.31, Q62.32, Q62.39, Q62.4, Q62.5, Q62.60, Q62.61, Q62.62, Q62.63, Q62.69, Q62.7, Q62.8, Q63.0, Q63.1, Q63.2, Q63.3, Q63.8, Q63.9, Q79.4, Q79.51, R80.1, R80.3, R80.8, R80.9, R82.991, R82.992, R82.993, R82.994, R88.0, T86.10, T86.11, T86.12, T86.13, T86.19, Z48.22, Z49.31, Z49.32, Z52.4, Z85.520, Z85.528, Z85.53, Z85.54, Z87.441, Z90.5, Z94.0. Dialysis (ICD-9): V45.1, V45.0, V56.1, V56.2, V56.3, V56.31, V56.32, V56.8, E879.1. Dialysis (ICD-10): I95.3, R88.0, T81.502A, T81.502D, T81.502S, T81.512A, T81.512D, T81.512S, T81.522A, T81.522D, T81.522S, T81.532A, T81.532D, T81.532S, T81.592A, T81.592D, T81.592S, T82.41XA, T82.41XD, T82.41XS, T82.42XA, T82.42XD, T82.42XS, T82.43XA, T82.43XD, T82.43XS, T82.49XA, T82.49XD, T82.49XS, T85.611A, T85.611D, T85.611S, T85.621A, T85.621D, T85.621S, T85.631A, T85.631D, T85.631S, T85.691A, T85.691D, T85.691S, T85.71XA, T85.71XD, T85.71XS, Y62.2, Y84.1, Z49.01, Z49.02, Z49.31, Z49.32, Z91.151, Z91.158, Z91.A5, Z99.2.
Serum Creatinine	Laboratory measurements taken during outpatient encounters.
Dialysis and Transplant	Beneficiaries with ≥ 1 inpatient or ≥ 2 outpatient encounters with ICD-9 or ICD-10 codes for dialysis or transplant were categorized separately and an eGFR was not calculated.
Age Standardization	Estimates were standardized to the 2010 U.S. Census population for adults: 18–39 years: 37.1%, 40–59 years: 38.1%, 60–69 years: 12.8%, and 70+ years: 12.0%.
Limitations of Indicator	The occurrence of CKD stages 1 and 2 cannot be calculated as urine albumin testing was not included. In the MHS, each year approximately 60% of all adults do not have an outpatient serum creatinine measured, and another 10% have serum creatinine measured only in the private sector with unavailable results.
Analytical Considerations	In published literature, CKD is defined by serum creatinine in alternate ways (single measurement, average of multiple measurements, persistence > 90 days). Care must be taken in making comparisons.