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Service Members and their Dependents with CKD Stages 3–5 who have a Diagnosis Code for CKD in the Military Health System

Overall, the crude prevalence of service members and their dependents in the Military Health System (MHS) with chronic kidney disease (CKD) stages 3–5 based on available outpatient serum creatinine values who also had an ICD-10-CM diagnosis code for CKD slightly increased from 31.6% in 2016 to 32.1% in 2019. Prevalence of CKD awareness among men and those with more advanced CKD tended to be higher than women.

Data Source: DoD-MHS

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Percentage of Service Members with CKD Stages 3-5 who have a Diagnosis Code for CKD in the Military Health System by Overall (%) Department of Defense Military Health System
2016	2017	2018	2019
31.6	32.0	32.3	32.1

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	Service members and their dependents with CKD stages 3–5 who have a diagnosis code for CKD in the Military Health System (MHS).
Data Set	U.S. 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	2016–2019.
Numerator	Service members and their dependents with an ICD-10-CM code for CKD.
Denominator	Service members and their dependents with outpatient serum creatinine measurement with estimated glomerular filtration rate (eGFR) <60 ml/min/1.73m² for at least 90 days.
Definition of CKD Stages 3–5	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 (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 0.9938age 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
ICD-10-CM Codes for CKD	A18.11, A52.75, B52.0, C64.x, C68.9, D30.0x, D41.0x-D41.2x, D59.3, E08.2x, E09.2x, E10.2x, E10.65, E11.2x, E11.65, E13.2x, E74.8, I12.xx, I13.0, I13.1x, I13.2, K76.7, M10.3x, M32.14, M32.15, N01.x-N08.x, N13.1, N13.1x-N13.39, N14.x,N15.0, N15.8, N15.9, N16, N17.x, N18.1-N18.5, N18.8, N18.9, N19, N25.xx, N26.1, N26.9, O10.4xx, O12.xx, O26.83x, O90.89, Q61.02, Q61.1x-Q61.8, Q26.0-Q26.39, R94.4 (x and xx stand for all the codes within the main diagnosis).
Serum Creatinine	Laboratory measurements taken during MHS visits.
Limitations of Indicator	Data is only available through 2019. 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.