Primary care providers were more successful in detecting CKD in patients with stages 3-5 and type 2 diabetes mellitus than in those with stages 1-2 and type 2 diabetes mellitus (T2DM); however, even late-stage CKD was difficult to detect, as providers only identified correctly 53% of those with stage 4 CKD and type 2 diabetes mellitus.
Chart Explanation: For all stages combined, detection of CKD by primary care providers in patients with T2DM in the Awareness, Detection and Drug Therapy in Type 2 Diabetes and Chronic Kidney Disease (ADD-CKD) cohort was 12.1% overall, suggesting that CKD is significantly underdiagnosed. Among patients with T2DM, primary care providers detected patients with later stage CKD more successfully than those with earlier stages of CKD. Detection was defined as documentation by a provider of the presence of CKD in either a clinical note or billing diagnosis prior to the first study visit. The likelihood of detecting CKD did not significantly differ by a provider’s practice setting, years in practice, or number of patients seen per week.
The Awareness, Detection and Drug Therapy in Type 2 Diabetes and Chronic Kidney Disease (ADD-CKD) cohort comprises of 9,339 adults with type-2 diabetes mellitus (T2DM) from 466 different primary clinic sites across the United States. The study participants reflected a broad geographical distribution and had a variety of health insurance plans. On average, every site or provider involved in the study had 21 study participants. Participants had to be older than 18 years to qualify for the study, and must have had T2DM for one year or longer. Patients on dialysis or with a functioning transplant were excluded from the study. The ADD-CKD study is an observational study that assessed the prevalence of both undiagnosed and detected CKD in the cohort between 2011 and 2012. Investigators used a clinician survey, a patient physical exam, a blood draw for eGFR and HbA1c, a urine dipstick, urine albumin-creatinine ratio, two patient quality of life questionnaires, and a 15-month medical review to assess CKD prevalence.
This indicator is based upon analysis in published literature: Szczech LA, Stewart RC, Su HL, et al. Primary care detection of chronic kidney disease in adults with type-2 diabetes: the ADD-CKD Study (awareness, detection and drug therapy in type 2 diabetes and chronic kidney disease). PLoS One
|Description of Measure||Primary Detection of CKD in patients with type 2 diabetes mellitus (T2DM)|
|Data Source||Awareness, Detection and Drug Therapy in Type 2 Diabetes and Chronic Kidney Disease (ADD-CKD) Cohort|
|Type of Data Source||An observational study|
|Data Set||The ADD-CKD Cohort|
|Health Care Data||No|
|Regional or National?||National|
|Demographic Group||Adults aged 18 years or older with T2DM from 466 different primary clinic sites across the United States|
|Numerator||Participants with CKD detected prior to first study visit|
|Denominator||All study participants|
|Definition of CKD||NKF KDOQI guidelines were used to define CKD based on estimated glomerular filtration rate (eGFR) values, urine ACR values, and proteinuria value|
|Primary Data Source Indicator||Detection of CKD by primary care provider|
|Primary Indicator Method of Measurement||Participants' medical records were reviewed over the course of the 15 month-long study in order to determine if their primary care provider had documented CKD in a clinical note or billing diagnosis; laboratory data and the medications prescribed by the primary care doctor were also reviewed|
|Frequency of Measurement||Once|
|Period Currently Available||2012|
|U.S. Region Covered by Primary Variable||All|
|Additional Data Items of Interest||Gender, race/ethnicity, body mass index (BMI), self-reported smoking|
|Limitations of Indicator||Stages of CKD may have been overestimated since there was only a single study assessment of ACR and eGFR|
|Analytical Considerations||The overestimation of all stages of CKD due to the single study assessment of ACR and eGFR make underdetection likely|
References and Sources:
Szczech LA, Stewart RC, Su HL, et al. Primary care detection of chronic kidney disease in adults with type-2 diabetes: the ADD-CKD Study (awareness, detection and drug therapy in type 2 diabetes and chronic kidney disease). PLoS One. 2014;9(11):e110535.