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Trends in Albuminuria Testing among Commercially Insured Patients with Diagnosed CKD

The prevalence of patients receiving albuminuria testing was 20.3% in 2007 and 35.4% in 2020. Albuminuria testing tended to be more frequent with older age except for those ≥ 70 years old. In 2020, prevalence of albuminuria testing was 33.4% among non-Hispanic White patients, 37.2% in non-Hispanic Black, and 42.2% in Asian patients. The largest improvement in testing was observed among Hispanic patients, from 34.0% in 2014 to 43.6% in 2020. The percentage of albuminuria testing was approximately 2.5 times as high among CKD patients with diabetes than those without diabetes. CKD patients with hypertension were approximately twice as likely to receive albuminuria testing than those without hypertension.

Data Source: Clinformatics Commercial

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Albuminuria Testing among Commercially Insured Patients with Diagnosed CKD by Overall (%) Clinformatics Commercial
2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	2017	2018	2019	2020
20.3 (95% CI: 19.9-20.6)	23.1 (95% CI: 22.8-23.5)	26.9 (95% CI: 26.6-27.2)	28.9 (95% CI: 28.6-29.2)	30.4 (95% CI: 30.1-30.6)	31.7 (95% CI: 31.5-32.0)	33.7 (95% CI: 33.5-33.9)	30.6 (95% CI: 30.4-30.8)	38.1 (95% CI: 37.9-38.3)	38.6 (95% CI: 38.4-38.7)	37.2 (95% CI: 37.1-37.4)	38.1 (95% CI: 38.0-38.2)	38.7 (95% CI: 38.6-38.8)	35.4 (95% CI: 35.3-35.5)

Data includes CKD stages 1–5. Data are not adjusted.

Clinformatics data sets provide paid medical and prescription claims and enrollment information for participants in commercial insurance plans and Medicare Advantage plans. The sample was limited to those enrolled in their health plan for all 12 months of the calendar year. Chronic kidney disease (CKD) and diabetes are defined using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), or Tenth Revision (ICD-10-CM) diagnosis codes. Outpatient pharmacy records of prescriptions filled for patients were examined for drugs in the sodium-glucose cotransporter-2 (SGLT2) inhibitors class. For inclusion in analyses, beneficiaries had to be in the enrollment file. To define CKD, diabetes, or hypertension, at least one inpatient or two outpatient claims were used.

Field	Data
Description of Measure	Urine albumin testing rates of patients with CKD diagnosis in the prior calendar year in Clinformatics Commercial population.
Data Set	Clinformatics Commercial from Optum Clinformatics Data Mart Database (Optum Insight, Eden Prairie, MN).
Population	Privately insured patients aged ≥ 20 years with at least one inpatient or two outpatient claims during the calendar year.
Years Included	2007–2020.
Numerator	Patients aged ≥ 20 years with albuminuria testing claims within the specified calendar year.
Denominator	Patients aged ≥ 20 years enrolled in Clinformatics Commercial insurance and diagnosed with CKD.
Definition of CKD	ICD-9-CM and ICD-10-CM diagnosis codes shown below.
ICD-10-CM Codes for CKD	Stages 1–2: N17.1, N17.2 Stages 3–5: N17.3, N17.4, N17.5 Any 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, , 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).
ICD-9-CM Codes for CKD	Stages 1–2: 585.1, 585.2 Stages 3–5: 585.3, 585.4, 585.5 Any CKD: 016.0, 095.4, 189.0,189.1, 189.9, 236.91, 250.4, 250.41, 250.42, 250.43, 271.4, 274.10, 283.11, 403.xx, 404.xx, 405.01, 405.11, 440.1, 442.1, 447.3, 453.3, 573.4, 580.xx, 581.xx, 582.xx, 583.xx, 584.5, 585.x, 587.xx, 588.xx, 590.xx, 591, 592.x, 593.xx, 642.1, 646.2, 753.xx, 794.4.
Albuminuria Testing	Urine Albuminuria is identified by Current Procedural Terminology (CPT®) codes (82042, 82043, 82044, and 84156).
Limitations of Indicator	As a measure of prevalence, the use of ICD-9-CM or ICD-10-CM diagnosis codes will underestimate prevalence of CKD.
Analytical Considerations	Consideration must be taken in comparisons based on diagnosis code-based definitions of CKD.