Kidney Health Evaluation

Chronic Kidney Disease (CKD) is a major driver of morbidity, mortality and high healthcare costs in the United States. Currently, 37 million American adults have CKD and millions of others are at increased risk (National Kidney Foundation [NKF], 2022), with an estimated population prevalence growing to nearly 17% among Americans aged 30 years and older by the year 2030 (Saran et al., 2019; Hoerger et al., 2015). Total Medicare spending in 2016 on both CKD and End-Stage Renal Disease (ESRD) was over $114 billion, comprising 23% of total Medicare fee-for-service spending overall with costs increasing exponentially with advancing CKD (Saran et al., 2019; Nichols et al., 2020). In the US from 2002-2016, the burden of CKD, defined as years of life lost, years living with disability, disability-adjusted life years, and deaths, outpaced changes in the burden of disease for other conditions (Bowe et al., 2018). Patients with CKD are readmitted to the hospital more frequently than those without diagnosed CKD (Saran et al., 2019). CKD is the 9th leading cause of death in the US and is the fastest growing non-communicable disease in terms of in burden largely due to death (Hoerger et al., 2015; Bowe et al., 2018). This public health issue is driven largely by the impact of diabetes—the most common comorbid risk factor for CKD (Saran et al., 2019; Bowe et al., 2018).  

The intent of this process measure is to improve rates of guideline-concordant kidney health evaluation in patients with diabetes to more consistently identify and potentially treat or delay progression of CKD in this high-risk population. Annual kidney health evaluation in patients with diabetes to determine risk of CKD using estimated glomerular filtration rate (eGFR) and urine albumin creatinine ratio (uACR) is recommended by clinical practice guidelines (American Diabetes Association, 2023; de Boer, 2022; NKF, 2007; NKF, 2012) and has been a focus of various local and national health care quality improvement initiatives, including Healthy People 2030 (Healthy People 2030, 2023). However, performance of these tests in patients with diabetes remains low, with rates that vary across Medicare (41.8%) and private insurers (49.0%) (Saran et al., 2019; Alfego et al., 2021; Stempneiwicz et al., 2021). Low rates of detection of CKD in a population of patients with diabetes have been demonstrated to be associated with low patient awareness of their own kidney health status (Szczech et al., 2014). Indeed, 90% of individuals with CKD are unaware of their condition due to under-recognition and under-diagnosis (Saran, et al., 2019; Centers for Disease Control and Prevention, 2023). Currently, an individual’s lifetime probability of developing CKD is relatively high, reaching 54% for someone currently aged 30-49 years (Hoerger et al., 2015). Regular kidney health evaluations, utilizing both eGFR and uACR, provide an opportunity to improve identification and potential reversal of worsening kidney function, particularly in high risk populations, such as those with diabetes.

This measure replaces and improves upon the previous Merit-Based Incentive Program (MIPS) medical attention for nephropathy measure. This measure is more specific as it requires utilizing the eGFR and uACR tests to assess a patient’s kidney health. 

References:

Alfego, D., Ennis, J., Gillespie, B., Lewis, M.J., Montgomery, E., Ferrè, S., … Letovsky, S. (2021). Chronic kidney disease testing among at-risk adults in the U.S. remains low: Real-world evidence from a National Laboratory database. Diabetes Care, 44(9), 2025-2032.https://doi.org/10.2337/dc21-0723

American Diabetes Association Professional Practice Committee. (2023). Chronic kidney disease and risk management: Standards of medical care in diabetes—2023.Diabetes Care, 46(Supplement_1), S191-S202. https://doi.org/10.2337/dc23-S011

Bowe, B., Xie, Y., Li, T., Mokdad, A. H., Xian, H., Yan, Y.,... Al-Aly, Z. (2018). Changes in the US burden of chronic kidney disease from 2002 to 2016. JAMA Network Open, 1(7).

Centers for Disease Control and Prevention. Chronic Kidney Disease in the United States. (2023). Retrieved from: https://www.cdc.gov/kidneydisease/publications-resources/ckd-national-facts.html

de Boer, I.H., Khunti, K., Sadusky, T., Tuttle, K.R., Neumiller, J.J., Rhee, Bakris, G. (2022). Diabetes management in chronic kidney disease: a consensus report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO). Kidney International, 102(5):974-989. doi: 10.1016/j.kint.2022.08.012

Healthy People 2030. Retrieved from: https://health.gov/healthypeople/objectives-and-data/browse-objectives/chronic-kidney-disease

Hoerger, T. J., Simpson, S. A., Yarnoff, B. O., Pavkov, M. E., Burrows, N. R., Saydah, S. H., . . . Zhuo, X. (2015). The future burden of CKD in the United States: A simulation model for the CDC CKD Initiative. American Journal of Kidney Diseases, 65(3), 403-411. doi:10.1053/j.ajkd.2014.09.023 

National Kidney Foundation. (2007). KDOQI Clinical practice guidelines and clinical practice recommendations for diabetes and chronic kidney disease. Retrieved from: https://www.kidney.org/sites/default/files/docs/diabetes_ajkd_febsuppl_07.pdf

National Kidney Foundation. (2012). KDOQI Clinical practice guideline for diabetes and CKD: 2012 Update. Retrieved from: http://www.kidney.org/sites/default/files/docs/diabetes-ckd-update-2012.pdf

National Kidney Foundation. (2022). About chronic kidney disease. Retrieved from: https://www.kidney.org/atoz/content/about-chronic-kidney-disease

Nichols, G.A., Ustyugova, A., Déruaz-Luyet, A., O’Keeffe-Rosetti, M., & Brodovicz, K.G. (2020). Health care costs by type of expenditure across eGFR stages among patients with and without diabetes, cardiovascular disease, and heart failure. Journal of the American Society of Nephrology, 31(7), 1594-1601. DOI: https://doi.org/10.1681/asn.2019121308

Saran R. B., Abbott K. C., Agodoa, L.Y.C., Bragg-Gresham, J., Balkrishnan, R., Shahinian, V. (2019). US renal data system 2018 annual data report: Epidemiology of kidney disease in the United States. American Journal of Kidney Diseases, 73(3). DOI: https://doi.org/10.1053/j.ajkd.2019.01.001

Stempneiwicz, N., Vassalotti, J.A., Cuddeback, J.K., Ciemins, E., Storfer-Isser, A., Sang, Y., … Coresh, J. (2021). Chronic kidney disease testing among primary care patients with type 2 diabetes across 24 U.S. health care organizations. Diabetes Care, 44(9), 2000-2009. DOI: https://doi.org/10.2337/dc20-2715

Szczech, L. A., Stewart, R. C., Su, H., Deloskey, R. J., Astor, B. C., Fox, C. H., . . . Vassalotti, J. A. (2014). 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, 9(11). DOI: https://doi.org/10.1371/journal.pone.0110535