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Prevalence of CKD Stages 3-5 in the Military Health System

The prevalence of chronic kidney disease (CKD) stages 3–5 within the Military Health System (MHS) has remained low, with 2% of service members and their dependents having eGFR below 60 ml/min/1.73 m². Prevalence trended lower between 2009 and 2015, with 1.7% of service members and their dependents having CKD stages 3–5 in 2015. Prevalence of CKD stages 3–5 is much higher among older service members and dependents. Female adults show a slightly higher prevalence (1.9% vs. 1.5% in 2015). Non-hispanic Black adults showed the highest prevalence of CKD stages 3–5 compared to other racial/ethnic groups.

Data Source: DoD-MHS

To view the prevalence of CKD stages 3–5 in MHS by risk categories, select from the drop-down menu below. Risk categories include Age, Sex, and Race.

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Prevalence of CKD Stages 3-5 in the Military Health System by Overall Department of Defense Military Health System
2009	2010	2011	2012	2013	2014	2015
2.2	2.0	1.7	1.8	1.7	1.7	1.7

The majority of service members and their dependents did not have eGFR estimates (73%) and were assumed to not have eGFR < 60 ml/min/1.73m²; therefore, prevalence may be underestimated. Data are not adjusted.

The US Department of Defense Military Health System (MHS) provides comprehensive primary and specialty care for more than 9.6 million active-duty personnel and military retirees and their families worldwide. The MHS Data Repository (MDR) is the administrative claims database for all care received through MHS, including direct care received in military treatment facilities and purchased care received in civilian treatment facilities. The MDR does not capture health care delivery in combat zones or care received in the VHA system. All patients were in the TRICARE Prime managed care option. Data are from both the direct care (military facilities) and private care (private facilities through TRICARE coverage) systems.

De-identified patient data were obtained from the MHS data repository. Data contain both the estimated glomerular filtration rate (eGFR) definition of chronic kidney disease (CKD) and claims-based CKD defined by using ICD-9-CM and ICD-10-CM codes diagnosis codes with at least one inpatient or two outpatient CKD diagnoses. To be included in analyses, service members and their dependents had to have at least one inpatient or outpatient record during the fiscal year (October 1 to September 30). Data cells with 10 or fewer patients were suppressed.

Disclaimer: The views expressed are those of the authors and do not reflect the official policy of the Uniformed Services University, Departments of Army/Navy/Air Force, Department of Defense, Centers for Disease Control and Prevention, Department of Health and Human Services, or US government.

Field	Data
Description of Measure	Prevalence of CKD stages 3–5 in MHS.
Data Set	US Department of Defense MHS Data Repository (MDR). MDR source files: CAPER (direct care outpatient claims), SIDR (direct care inpatient claims), TED-NI (purchased care outpatient claims), TED-I Header (purchased care inpatient claims), and VM6BEN (demographic information from the Defense Enrollment Eligibility Reporting System).
Population	Service members and their dependents in MHS.
Years Included	2009–2015.
Numerator	Service members and their dependents with eGFR < 60 ml/min/1.73m² for at least 90 days.
Denominator	Service members and their dependents with at least one outpatient or inpatient visit during the fiscal year (October 1 to September 30).
Definition of CKD and CKD Stage	CKD is defined by estimated glomerular filtration rate (eGFR): stage 3: eGFR 30–59 ml/min/1.73 m²; stage 4: eGFR 15–29 ml/min/1.73 m²; stage 5: eGFR < 15 ml/min/1.73 m² for at least 90 days, excluding dialysis or transplant patients.
Estimated glomerular filtration rate (eGFR)	Based on the CKD-EPI equation for calibrated creatinine: eGFR=141 x [min(serum creatinine in mg/dL) /κ, 1)]α x [max(serum creatinine/κ, 1)]-1.20 x 0.993age x (1.018 if female) x (1.159 if a Black person). κ = 0.7 if female and 0.9 if male α = -0.329 if female and -0.411 if male = raise to the power
Serum Creatinine	Laboratory measurements taken during MHS visits.
Diabetes	Diabetes status determined by at least one inpatient or two outpatient diagnoses based on the presence of an ICD-9-CM code (250.xx, 357.2, 336.41, 362.01, 362.02; x and xx stand for all the codes within the main diagnosis).
Hypertension	Hypertension status determined by at least one inpatient or two outpatient diagnoses based on the presence of an ICD-9-CM code (401.x through 405.x; x stands for all the codes within the main diagnosis).
Limitations of Indicator	Data is only available through 2015. The majority of service members and their dependents did not have eGFR estimates (73%) and were assumed to not have eGFR < 60 ml/min/1.73m²; therefore, prevalence may be underestimated.
Analytical Considerations	Service members and their dependents in MHS tend to be younger and healthier than the general population. Therefore, testing for serum creatinine and UACR are performed less frequently than in other health care systems.