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Trends in Percentage of U.S. Veterans with CKD Stage 4 Seeing a Nephrologist

Trends in Percentage of U.S. Veterans with CKD Stage 4 Seeing a Nephrologist

As kidney disease progresses, guidelines recommend that patients with CKD stage 4 are referred for nephrology evaluation in order to slow CKD progression to kidney failure and manage CKD-related complications. Between 2018 and 2022, 42%−51% of non-Hispanic Black veterans had at least one annual nephrologist visit and 32%−36% of non-Hispanic White veterans had nephrologist visits. No trend was noticed over time, although a drop was observed between 2020 and 2021, possibly due to the COVID-19 pandemic.

Data Source: NATIONAL VA

To view the proportion of those with a nephrology visit by risk categories, select from the drop-down menu below. Risk categories include: Overall, Age Category, Sex, Race/Ethnicity, Diabetes, and Hypertension.


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eGFR range is determined by laboratory values. Data are not adjusted.

VHA is America’s largest integrated health care system, providing care at 171 medical centers and 1,113 outpatient sites. VHA serves over 9 million enrolled Veterans each year. National VHA data were examined for Veterans with at least one outpatient visit during the federal fiscal year (October 1 to September 30). Medical conditions were defined by ICD-9-CM and ICD-10-CM diagnosis codes on at least one outpatient claim.

Description of Measure

Trends in percentage of at least one nephrology visit among U.S. veterans with CKD stage 4.

Data Set

Veterans Health Administration (VHA) national data; MedSAS data; MCA prescription data; Corporate Data Warehouse (CDW) LabChem.


Patients in VHA, including fee-based patients (i.e., veterans receiving care outside of VHA that was paid by VHA).

Years Included



U.S. veterans aged ≥18 years with CKD stage 4 who had at least one nephrology visit within the year.


U.S. veterans aged ≥18 years with CKD stage 4.

Definition of CKD Stage 4

CKD stage 4 is defined by an estimated glomerular filtration rate (eGFR) of 15–29 ml/min/1.73 m².

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 0.9938**age 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

Serum Creatinine

Laboratory measurements taken during outpatient appointments.

Limitations of Indicator

CKD codes may be underestimated from claims data.

Analytical Considerations

Not all veterans use the VHA Health System.

  • Kidney Disease Improving Global Outcomes (KDIGO). KDIGO Clinical Guidelines for Acute Kidney Injury. Kidney Int. 2012:2(Supp. 1).