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Trends in Incidence Rate of CKD among U.S. Veterans

Trends in Incidence Rate of CKD among U.S. Veterans

Incidence of CKD among U.S. Veterans tended to have slowly increased from 63 new cases in 2006 to 72 new cases per 1,000 patient years in 2022. The incidence tended to be highest among the oldest age groups, 60−69 years to 70 years and older (> 60 new cases per 1,000 patient-years) and among non-Hispanic Black veterans (85 new cases per 1,000 patient-years) in 2022. The lowest rates were seen among Asian Veterans. Women veterans have much lower incidence rates than men (37 vs. 77 new cases per 1,000 patient-years in 2022). The rates overall were three times higher among those with diabetes or hypertension than those without these conditions.

Data Source: NATIONAL VA

To view the incidence of kidney disease in Veterans by risk categories, select from the drop-down menu below. Risk categories include Overall, Age, Sex, Race/Ethnicity, Diabetes, and Hypertension.

CKD Incidence Rate, Overall
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eGFR range is determined by laboratory values, while dialysis and transplantation were defined by ICD-9 & ICD-10 diagnosis or CPT codes. All categories are mutually exclusive. 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.

FieldData
Description of Measure

Incidence rate of chronic kidney disease among U.S. Veterans.

Data Set

Veterans Health Administration (VHA) national data, using the MedSAS data, MCA prescription data, and the Corporate Data Warehouse (CDW) LabChem files.

Population

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

Years Included

2008–2022.

Numerator

Veterans with any CKD stage 1−5, dialysis, or kidney transplant.

Denominator

Veterans aged ≥18 years with no indication of CKD (by diagnosis code, serum creatinine, or urine albumin level) or ESRD in the prior two years.

Definition of CKD

CKD is defined by an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m² or albuminuria (urine albumin to creatinine ratio [UACR] ≥ 30 mg/g), any diagnostic ICD code for CKD, dialysis, or kidney transplant.

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.

Dialysis and Transplant

Dialysis and transplantation were determined from ICD-9 and ICD-10 codes as follows:

Dialysis: ICD-9, V56.x, E879.1x, 585.6; ICD10, N18.6, Y84.1, V56, Z49.01, Z49.02, Z49.31, Z49.32, Z91.15, Z99.2; outpatient CPT codes, 90918, 90919, 90921, 90922, 90923, 90925, 90935, 90937, 90940, 90945, 90947, 90951, 90952-90967, 90997, 90999 and outpatient dialysis clinic (600-611) visits.

x and xx stand for all the codes within the main diagnosis.

Transplantation: ICD-9, V42.0, 996.81; ICD10, T86.1x, Z48.2x, Z49.xx and if the transplant occurred within VHA (DRG 302, 512 before FY17, 008, 652 after FY17). Procedure/surgery codes: ICD-9,556.9, ICD10, OTYO1, and OTYO2.

Limitations of Indicator

CKD codes may be underestimated from claims data.

Analytical Considerations

Not all Veterans use the VHA Health System. These data were not linked to the CMS ESKD program data, so the dialysis and transplant categories may underestimate the true prevalence of ESRD among Veterans. It is likely that some Veterans with eGFR <15 ml/min/1.73m2 in CKD stage 5 receive dialysis outside the VHA Health System.

  • Inker LA, Eneanya ND, Coresh J, et al.; Chronic Kidney Disease Epidemiology Collaboration. New Creatinine- and Cystatin C-Based Equations to Estimate GFR without Race. N Engl J Med. 2021 Nov 4;385(19):1737-1749. PMID: 34554658.



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