Indicator Details: Acute Coronary Syndrome Rates by eGFR Category
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Published literature or one-time analysis, ongoing surveillance not available Published literature or one-time analysis, ongoing surveillance not available

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The 1-year risk of being hospitalized for an acute coronary syndrome was substantially higher at lower eGFR levels even after accounting for differences in age and sex in a large, community-based population receiving care within an integrated health care delivery system in northern California. However, across all eGFR levels, there were favorable temporal trends in hospitalizations for acute coronary syndromes between 2000 and 2008, with larger absolute changes at lower eGFR levels. The focus of these analyses was on CKD before the onset of ESRD, so information was not available on acute coronary syndrome rates in patients receiving chronic dialysis or renal transplant. In addition, information on outpatient sudden cardiac death events due to an acute coronary syndrome was also unavailable.
Chart Explanation: The age-sex-adjusted risk of being hospitalized for an acute coronary syndrome (acute myocardial infarction or unstable angina) at 1 year was higher with lower eGFR levels in each calendar year between 2000 and 2008 in a large, community-based population receiving care within an integrated health care delivery system in northern California. Across all eGFR categories, there were lower 1-year risks of being hospitalized for an acute coronary syndrome in later years during the study period, with the absolute reductions being larger at lower eGFR levels. As the focus of these analyses was on CKD before the onset of ESRD, information was not available on hospitalizations for acute coronary syndromes in patients receiving chronic dialysis or renal transplant. Information on outpatient sudden cardiac death events due to an acute coronary syndrome was also unavailable.
The source population was Kaiser Permanente Northern California, a large integrated health care delivery system that provides comprehensive inpatient and outpatient care for >3.2 million members in the San Francisco and greater Bay Area. The Kaiser Permanente Northern California population is highly representative of the local surrounding and statewide population with regards, to age, gender, race/ethnicity and comorbidity burden, with only slightly lower representation at the extremes of age and income.  The study samples included all Kaiser Permanente Northern California adult members aged 40 years or older as of January 1st of each calendar year of interest and who had known eGFR of 150 ml/min/1.73 m2 or less based on ambulatory, non-emergency department serum creatinine measures found in health plan databases. Estimated GFR was calculated using the CKD-EPI equation. Given the focus on CKD before the onset of ESRD, all patients with prior chronic dialysis or receipt of renal transplant were excluded.

For each calendar year’s eligible cohort, patients were stratified by eGFR category (90-150, 60-89, 45-59, 30-44, 15-29 and <15 ml/min/1.73 m2 not receiving renal replacement therapy). Given the relatively low frequency of testing for urine protein excretion, albuminuria was not included in these analyses.  Hospitalizations for an acute coronary syndrome were identified based on relevant International Classification of Diseases, Ninth Edition (ICD-9) diagnostic codes based on discharge diagnoses (410.x1 in the primary position; 411.x in the primary position or the combination of 414.0 in the primary position and 411.x in any secondary position) found in health plan hospitalization databases for admissions to Kaiser Permanente-owned hospitals and through billing claims databases for admissions to non-network hospitals. Prior validation studies have demonstrated a very high positive predictive value for acute coronary syndromes using this approach. The 1-year risk of being hospitalized for an acute coronary syndrome was calculated by calendar year for each eGFR category and adjusted for age and sex using direct adjustment methods and the 2008 cohort as the referent group.

This material is the result of work supported with resources from the Centers for Disease Control as well as Kaiser Permanente Northern California, Oakland, CA.
FieldData
Description of MeasureAge-sex-adjusted 1-year risk of hospitalization for an acute coronary syndrome
Data SourceKaiser Permanente Northern California electronic medical record system and billing claims databases
Type of Data SourceClinical, demographic and vitals status data
Data SetKaiser Permanente Northern California adult members aged ≥40 years with eGFR ≤150 ml/min/1.73 m2 between January 1, 2000 and December 31, 2008
Health Care System DataYes
Regional or National?Regional
Demographic GroupKaiser Permanente Northern California adult members aged ≥40 years with eGFR ≤150 ml/min/1.73 m2 between January 1, 2000 and December 31, 2008
NumeratorPatients in denominator who died in the calendar year
DenominatorPatients aged ≥40 years who had eGFR ≤150 ml/min/1.73 m2 as of January 1st of the calendar year of interest
Primary Data Source IndicatorAdmission date for hospitalization for heart failure
Primary Indicator Method of MeasurementHospitalizations for acute coronary syndromes were based on relevant International Classification of Diseases, Ninth Edition (ICD-9) diagnostic codes based on discharge diagnoses (410.x1 in the primary position; 411.x in the primary position or the combination of 414.0 in the primary position and 411.x in any secondary position) found in health plan hospitalization databases for admissions to Kaiser Permanente Northern California-owned hospitals and through billing claims databases for admissions to non-network hospitals.
Secondary (1) Variable : Category of eGFReGFR 90-150 ml/min/1.73 m² eGFR 60-89 ml/min/1.73 m² eGFR 45-59 ml/min/1.73 m², eGFR 30-44 ml/min/1.73 m², eGFR 15-29 ml/min/1.73 m², and <15 ml/min/1.73 m² not receiving dialysis or renal transplant
Glomerular Filtration RateEstimated using the CKD-EPI equation:
Frequency of Measurement (Primary)Once per qualifying calendar year
Period Currently Available2008
Limitations of IndicatorGiven the focus on CKD before the onset of ESRD, information on patients receiving chronic dialysis or a renal transplant is not included.  Information on outpatient sudden cardiac death events due to an acute coronary syndrome was also unavailable
Suggested Citation:
Centers for Disease Control and Prevention. Chronic Kidney Disease Surveillance System—United States.
website. http://www.cdc.gov/ckd