Indicator Details: Predictors of Pre-ESRD Carea
Data Sources
 
Stratification and Year Choices:

  Source
  • CMS-ESRD

  Chart Format


Published literature or one-time analysis, ongoing surveillance not available Published literature or one-time analysis, ongoing surveillance not available

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Footnotes:
a All Odds Ratios (OR) were significant at the p < 0.0001 level with the exception of: Asian/Pacific Islander (p = 0.04), Native American (p = 0.16) and ‘Other’ (p = 0.15) Race/Ethnicities; Ages < 20 years (p = 0.50) and 65-74 years (p = 0.01); GFR of 10-14.9 ml/min/m² (p = 0.02); and ‘Missing’ Albumin values (p = 0.14).




Females, patients with diabetes, whites, non-Hispanics, and older patients were more likely to have received pre-ESRD nephrology care.

Patients starting treatment on hemodialysis with a fistula were also more likely to have received pre-ESRD nephrology care.
Chart Explanation: Predictors of pre-ESRD nephrology care were investigated. Females, patients with diabetes, whites, non-Hispanics, and older patients were more likely to have received pre-ESRD nephrology care. In addition, patients with higher hemoglobin or albumin values, patients with mid-range eGFR values (5-14.9 ml/min/1.73 m²) and patients starting treatment on hemodialysis with a fistula were also more likely to have received pre-ESRD nephrology care.
Within the United States, health insurance for all individuals with end-stage renal disease (ESRD) is covered by the Centers for Medicare and Medicaid Services. These results were taken from analyses using 100% of the national ESRD population data. 

Beginning in June 2005, information related to pre-ESRD care was collected on all new ESRD patients via the Medical Evidence Form (CMS-2728). In November 2007, researchers presented “Earlier Pre-ESRD Care Throughout the U.S. is Associated with Better Survival for Dialysis Patients in Their First Year of ESRD” (Saran et al., 2007) at the 2007 annual meeting of the American Society of Nephrology. Utilizing national CMS data and data collected on the form CMS-2728 for 52,277 incident ESRD patients between June 1, 2005 and December 31, 2005 who survived to day 90 of ESRD treatment, timing of pre-ESRD nephrology care, dietitian care and EPO treatment were investigated. A patient was considered under the care of a nephrologist, kidney dietitian, or EPO treated if their form indicated “Yes” in the check box for the corresponding question; if the box “No” was checked, the patient was classified as none; if the box “Unknown” was checked, the patient was classified as unknown. Timing of pre-ESRD care was assigned according to the check box on the form indicating “6-12 months,” “>12 months,” or assigned “<6 months” if the form indicated treatment but the length of treatment box was left unchecked.
FieldData
Description of MeasurePre-ESRD care
Data SourceCenters for Medicare and Medicaid Services Medical Evidence Form (CMS-2728)
Type of Data SourceAdministrative
Data SetCMS
Health Care System DataNo
Regional or National?National
Demographic GroupIncident dialysis patients
NumeratorAll individuals in denominator
Denominator52,277 ESRD patients incident between 6/1/05 and 12/31/05 who survived to day 90 of ESRD treatment
Definition of diagnosed CKDStage 5 with Medicare-eligibility for ESRD treatment
Primary Data Source IndicatorNephrology care, Dietitian care and Erythropoietin (EPO) treatment immediately prior to ESRD
Primary Indicator Method of MeasurementReported on CMS-2728 form
Secondary (1) VariableDemographics (e.g. age, gender, race/ethnicity), Health (e.g. BMI, diabetes status, dialysis modality), Labs (e.g. serum creatinine, urine albumin, hemoglobin)
Secondary (1) Variable Method of MeasurementAll as reported on CMS 2728 form
Secondary (2) VariableeGFR
Secondary (2) Variable Method of MeasurementCalculated using 4-variable, MDRD-study formula using data from CMS 2728 form
Secondary (4) VariableMortality
Secondary (4) Variable Method of MeasurementMultiple sources: CROWNWeb (Consolidated Renal Operations in a Web-enabled format) Form 2746, Renal Management Information System (REMIS), ESRD Death Notification
Frequency of Measurement (Primary)Once
Period Currently Available2005
Additional Data Items of InterestTracking of care immediately prior to ESRD registration began in 2005.
Limitations of IndicatorInformation on pre-ESRD care is self-reported. Some 10-18% of individuals were unsure of their pre-ESRD care level.
References and Sources:
  • Gillespie BW, Morgenstern H, Hedgeman E, et al. Nephrology care prior to end-stage renal disease and outcomes among new ESRD patients in the USA. Clin Kidney J. 2015 Dec;8(6):772-80.
  • Saran R, et al. Earlier pre-ESRD care throughout the United States is associated with better survival for dialysis patients in their first year of ESRD. J Am Soc Nephrol 18: 299A, 2007
Suggested Citation:
Centers for Disease Control and Prevention. Chronic Kidney Disease Surveillance System—United States.
website. http://www.cdc.gov/ckd