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Trends in Testing of Serum Creatinine, Albuminuria, and Lipid Levels among Commercially Insured Patients with Diagnosed CKD

The prevalence of patients receiving testing for serum creatinine, lipid levels, and urine albumin to creatinine ratio during the same calendar year was 15.1% in 2007 and 27.7% in 2020. Prevalence of testing was more common in older age groups and was more than twice as high for patients with than without diabetes. Patients with hypertension were approximately twice as likely to receive all three tests than those without hypertension. Patients with CKD stages 3 and 4 tended to have a higher prevalence of receiving all three tests.

Data Source: Clinformatics Commercial

To view serum creatinine, albuminuria, and lipid testing by risk categories, select from the drop-down menu below. Risk categories include: Overall, Age Category, Sex, Race/Ethnicity, CKD Stage, Diabetes, and Hypertension.

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Combined Testing of Serum Creatinine, Albuminuria, and Lipids 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
15.1 (95% CI: 14.8-15.4)	17.1 (95% CI: 16.8-17.4)	20.2 (95% CI: 19.9-20.4)	21.8 (95% CI: 21.5-22.0)	22.7 (95% CI: 22.5-23.0)	23.9 (95% CI: 23.7-24.1)	25.4 (95% CI: 25.2-25.6)	22.9 (95% CI: 22.7-23.0)	29.5 (95% CI: 29.3-29.7)	29.7 (95% CI: 29.6-29.9)	28.6 (95% CI: 28.5-28.8)	29.5 (95% CI: 29.4-29.6)	30.3 (95% CI: 30.2-30.4)	27.7 (95% CI: 27.6-27.8)

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.

Placeholder Method

Field	Data
Description of Measure	Combined serum creatinine, albuminuria, and lipid testing rates of patients with CKD diagnosis in the prior calendar year in Clinformatics Commercial population.
Placeholder FieldText	Placeholder DataText
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 serum creatinine, urine creatinine, urine albumin or UACR testing, and lipid 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	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).
ICD-9-CM Codes for 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.
Serum Creatinine, Albuminuria, and Lipid Testing	Serum creatinine, albuminuria, and lipid testing is defined as having at least one serum creatinine testing claim, at least one either both urine creatinine and urine protein/albumin or UACR testing claim, and at least one lipids testing claim within the specified calendar year. Lab testing is defined using Current Procedural Terminology (CPT®) codes as follows: Urine protein/albumin: 82042, 82043, 82044, 84156, 84166 Urine creatinine: 82570 UACR: 84156, 82570 Serum creatinine: 82565, 80047, 80048 ,80053 and 80069 Lipids: 83718, 83721, 80061, 82465, 83719, 84478
Limitations of Indicator	As a measure of prevalence, the use of ICD-9-CM or ICD-10-CM diagnosis codes will underestimate CKD.
Analytical Considerations	Consideration must be taken in comparisons based on diagnosis code-based definitions of CKD.