There is higher mortality among those with higher degrees of renal dysfunction. Note that this data has not been matched to Center for Medicare and Medicaid Studies (CMS) ESRD program data, so the dialysis and transplant categories underestimate the true prevalence of ESRD among veterans. Some of the veterans with eGFR < 15 in Stage 5 in this figure may be receiving dialysis outside the VA health system.
Chart Explanation: Mortality was higher for more advanced stages of CKD and highest for those with CKD stage 5 (non-dialysis). Note that this data has not been matched to Center for Medicare and Medicaid Studies (CMS) ESRD program data, so the dialysis and transplant categories underestimate the true prevalence of ESRD among veterans. Some of the veterans with eGFR < 15 in Stage 5 in this figure may be receiving dialysis outside the VA health system.
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 inpatient and outpatient diagnosis codes (ICD-9-CM: 5856) to indicate dialysis. Kidney transplant patients were identified by inpatient and outpatient ICD-9-CM diagnosis code V420 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 Healthcare System, Ann Arbor, Michigan.
|Description of Measure||All-cause mortality rate (per 1,000 patient-years)|
|Type of Data Source||Administrative Data|
|Data Set||VA National Data, using the MedSAS data files|
|Health Care System Data||Yes|
|Regional or National?||National|
|Demographic Group||Patients in VA Health system|
|Numerator||Patients in the denominator who died in the fiscal year|
|Denominator||Patients aged ≥20 who have at least one outpatient visit within the specified kidney function group|
|Primary Data Source Indicator||Reported death date|
|Primary Indicator Method of Measurement||The date of death is from the VA Vital Status Master file. This file contains deaths ascertained from family, VA hospitals, VA National Cemetery Administration, Social Security Death Master File, and the Centers for Medicare and Medicaid Services. |
|Secondary (1) Variable : CKD by eGFR||eGFR ≥90 ml/min/1.73 m²
eGFR 60-89 ml/min/1.73 m²
Stage 3, eGFR 30-59 ml/min/1.73 m²
Stage 4, 15-29 ml/min/1.73 m²
Stage 5, <15 ml/min/1.73 m²
Stage 5D, on dialysis
Stage 5T, transplant|
|Glomerular filtration rate||Estimated using the CKD-EPI equation: eGFR=141 X min(SCR/K,1)**A X max(SCR/K,1)**-1.209 X 0.993**Age X 1.018[if female] X 1.159[if black] where SCR is serum creatinine in mg/dl, min is the minimum of SCR/K or 1, max is the maximum of SCR/K or 1, K=0.7 for female or K=0.9 for male, A is -.329 for female and -.411 for male. Missing race/ethnicity was coded as white. ** signifies "raised to the power of".|
|Frequency of Measurement (Primary)||Once|
|Period Currently Available||2012|
|Limitations of Indicator||For ESRD patients, death information may be incomplete as these individuals often have dual coverage and may have been utilizing a different health care system for ESRD services.|