The fraction of veterans with urine albumin laboratory results is increasing over time in each age group, though urine albumin testing is done less frequently than serum creatinine testing. The percentage with urine albumin results increased from 1% to 7% for veterans aged 20 to 29 years; from 3% to 9% for veterans 30 to 39 years; from 5% to 16% for veterans 40–49 years; from 10% to 22% for veterans 50 to 59 years; from 12% to 27% for veterans 60 to 69 years; and from 10% to 25% for veterans 70 years or older.
Chart Explanation: These charts show percentage of patients with urine albumin laboratory results by age and year of observation or CKD risk factor (gender, race/ethnicity, diabetes or hypertension) status.
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 ICD-10-CM: N186, Y841, Z4931, Z4901, Z4902, Z4931, Z4932, and Z4933) to indicate dialysis. Kidney transplant patients were identified by inpatient and outpatient ICD-9-CM diagnosis code V420, 99681, ICD-10 CM diagnosis code T86X, Z4822 and Z940, and inpatient procedure and surgery codes (55.69)
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.
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||Urine Protein Testing Practices|
|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 denominator who had a laboratory result for urine albumin or urine albumin:creatinine ratio.|
|Denominator||Patients aged >20 who have at least one outpatient visit, within specified age group.|
|Primary Data Source Indicator||Urine microalbumin or microalbumin:creatinine ratio test results|
|Primary Indicator Method of Measurement||Laboratory|
|Secondary (1) Variable||Age = (Date of Visit - Date of Birth)/365.25|
|Secondary (1) Indicator Method of Measurement||Outpatient Visit|
|Secondary (2) Variable||Hypertension status determined by ICD-9-CM code (401, 402, 403, 404, 405 ) and/or prescribed antihypertensive medication (outpatient only).|
|Secondary (2) Indicator Method of Measurement||Outpatient visit and pharmacy data|
|Frequency of Measurement (Primary)||Multiple measurements per patient|
|Period Currently Available||2005–2018|
|Limitations of Indicator||The VA health care system is a closed system – most laboratory requests are processed internally, and payment is generally not dependent upon the presence of a CPT code. Hence procedural codes and serum creatinine lab results do not always correlate.|