Chapter 2: Identification and Care of Patients With CKD 2015 A NNUAL D ATA R EPORT V OLUME 1: C HRONIC K IDNEY D ISEASE

Table A. ICD-9-CM Codes Vol 1, CKD, Ch 22 Table A. ICD-9-CM codes for Chronic Kidney Disease (CKD) stages ICD-9-CM code a Stage 585.1CKD, Stage CKD, Stage 2 (mild) 585.3CKD, Stage 3 (moderate) 585.4CKD, Stage 4 (severe) 585.5CKD, Stage 5 (excludes 585.6: Stage 5, requiring chronic dialysis b ) CKD Stage- unspecified For these analyses, identified by multiple codes including 585.9, 250.4x, 403.9xm & others a For analyses in this chapter, CKD stage estimates require at least one occurrence of a stage-specific code, and the last available CKD stage in a given year is used. b In USRDS analyses, patients with ICD-9-CM code & with no ESRD 2728 form or other indication of end-stage renal disease (ESRD) are considered to have code

Vol 1, CKD, Ch 23 Table 2.1 Prevalence of coded comorbid conditions (CKD, CVD & DM), (a) total, and (b) one or more, among Medicare patients aged 65+, 2013 Data Source: Special analyses, Medicare 5 percent sample. Period prevalent patients, 2013, without ESRD, aged 65 and older (Medicare). Abbreviations: CKD, chronic kidney disease; CVD, cardiovascular disease; DM, diabetes mellitus. CVD is defined as presence of any of the following comorbidities: cerebrovascular accident, peripheral vascular disease, atherosclerotic heart disease, congestive heart failure, dysrhythmia or other cardiac comorbidities. (b) (a) N% 5% Medicare patients1,260, Total CKD134, Total CVD499, Total DM301, N% 5% Medicare patients1,260, Only CKD22, Only CVD285, Only DM117, CKD & DM, no CVD17, CKD & CVD, no DM47, DM & CVD, no CKD118, CKD & CVD & DM47, No CKD, no CVD, no DM604,

Vol 1, CKD, Ch 24 Table 2.2 Demographic characteristics of all patients and of CKD patients, among Medicare patients aged 65+, 2013 Data Source: Special analyses, Medicare 5 percent sample. Period prevalent patients, 2013, without ESRD, aged 65 and older (Medicare). Abbreviations: CKD, chronic kidney disease; CVD, cardiovascular disease; DM, diabetes mellitus; HTN, hypertension. CVD is defined as presence of any of the following comorbidities: cerebrovascular accident, peripheral vascular disease, atherosclerotic heart disease, congestive heart failure, dysrhythmia or other cardiac comorbidities. All patientsPatients with CKD N(%)N All1,260, , Age , , , , , , Sex Male543, , Female717, , Race White1,086, , Black/African American95, , Native American5, Asian23, , Other41, , Unknown7, Comorbidity DM301, , HTN755, , CVD499, ,

Vol 1, CKD, Ch 25 Table 2.3 Prevalence of CKD, and adjusted odds ratios of CKD among Medicare patients aged 65+, 2013 Data Source: Special analyses, Medicare 5 percent sample. Period prevalent patients, 2013, without ESRD, aged 65 and older (Medicare). Adjustments included are age, gender, race, and comorbidities. Abbreviations: CKD, chronic kidney disease; CVD, cardiovascular disease; DM, diabetes mellitus; HTN, hypertension. CVD is defined as presence of any of the following comorbidities: cerebrovascular accident, peripheral vascular disease, atherosclerotic heart disease, congestive heart failure, dysrhythmia or other cardiac comorbidities. Prevalence of CKD (% of overall) Adjusted odds ratios of CKD Overall10.7 Age Ref Sex Male Female9.8Ref. Race White10.3Ref. Black/African American Native American Asian Other/Unknown Comorbidity DM HTN CVD

Vol 1, CKD, Ch 26 Table 2.4 Percent of patients with CKD by demographic characteristics, among patients overall and with DM, HTN, or CVD, in NHANES ( ) and Medicare (2013) datasets Data Source: Special analyses, Medicare 5 percent sample, aged 65 and older alive & eligible for all of 2013 and NHANES participants, aged 65 and older. CKD claims as well as other diseases identified in Abbreviations: CKD, chronic kidney disease; CVD, cardiovascular disease; DM, diabetes mellitus; HTN, hypertension. * Values for cells with 10 or fewer patients are suppressed. a CVD defined as any of the self-report diseases: angina, myocardial infarction, stroke, coronary heart disease, or congestive heart failure. b CVD defined as either one of the following comorbidities: cerebrovascular accident, peripheral vascular disease, atherosclerotic heart disease, congestive heart failure, dysrhythmia or other cardiac comorbidities. - No available data. OverallDM (No HTN)HTN (No DM)Any CVD NHANESMedicareNHANESMedicareNHANESMedicareNHANES a Medicare b Age * * Race White Black/ African American * Native American Asian Other/Unknown Sex Male Female All

Vol 1, CKD, Ch 27 Figure 2.1 Trends in prevalence of recognized CKD, overall and by CKD stage, among Medicare patients aged 65+, Data Source: Special analyses, Medicare 5 percent sample. Known CKD stages presented as bars; curve showing “All codes” includes known CKD stages (codes ) and the CKD-stage unspecified codes (585.9, and remaining non-585 CKD codes). Note: In previous years, this graph reported codes as a component of the stacked bars. Abbreviation: CKD, chronic kidney disease.

Vol 1, CKD, Ch 28 Figure 2.2 Trends in prevalence of recognized CKD, by race, among Medicare patients aged 65+, Data Source: Special analyses, Medicare 5 percent sample. Abbreviation: CKD, chronic kidney disease; Af Am, African American; Native Am, Native American.

Vol 1, CKD, Ch 29 Table 2.5. Progression of CKD from 2008 to 2013, Medicare 5% cohort alive and not yet ESRD in 2008 Data Source: Special analyses, Medicare 5 percent sample. Patients alive & eligible for all of Death and ESRD status were examined yearly between , and carried forward if present. If ESRD occurred before death, the death information was used. Among patients without death or ESRD by 2013 the last CKD diagnosis claim was used; if not available, then the last CKD diagnosis claim from 2012 was used. Lost to follow-up represents the patients that did not have 2013 data available. Abbreviations: CKD, chronic kidney disease; ESRD, end-stage renal disease Status Total No CKD diagnosis CKD Stage 1 CKD Stage 2 CKD Stage 3 CKD Stage 4 CKD Stage 5 CKD Stage- Unspecified ESRDDeath Lost to follow-up 2008 status No CKD diagnosis N1,132,034643,7872,2418,07443,1805,9041,45942,2261, , ,304 % CKD Stage 1 N2, , % CKD Stage 2 N5, , , % CKD Stage 3 N29,3292, ,7451, , ,4392,263 % CKD Stage 4 N8, , , % CKD Stage 5 N2, , % CKD Stage- Unspecified N44,4798, ,3971, , ,7733,437 % Any CKD N92,92512, ,69514,5454, ,8371,94542,9396,975 % Total N1,224,959656,4682,7669,76957,72510,0502,09649,0633, , ,279 %

Vol 1, CKD, Ch 210 Figure 2.3 Trends in proportion of patients with (a) urine albumin & (b) serum creatinine testing, by year, among Medicare patients aged 65+ WITHOUT a diagnosis of CKD, (a) Urine albumin (b) Serum creatinine Data Source: Special analyses, Medicare 5 percent sample, aged 65 and older with Part A & B coverage in the prior year. Tests tracked during each year. Abbreviations: CKD, chronic kidney disease; DM, diabetes mellitus; HTN, hypertension.

Vol 1, CKD, Ch 211 Figure 2.4 Trends in Proportion of patients with (a) urine albumin & (b) serum creatinine testing, by year, among Medicare patients aged 65+ WITH a diagnosis of CKD, Data Source: Special analyses, Medicare 5 percent sample, aged 65 and older with Part A & B coverage in the prior year. Tests tracked during each year. Abbreviations: CKD, chronic kidney disease; DM, diabetes mellitus; HTN, hypertension. (a) Urine albumin (b) Serum creatinine

Vol 1, CKD, Ch 212 Figure 2.5 Proportion of patients with (a) urine albumin & (b) serum creatinine testing by demographic characteristics, adjusted for age, race and gender, among Medicare patients aged 65+ WITHOUT a diagnosis of CKD, 2013 Data Source: Special analyses, Medicare 5 percent sample. Models are adjusted for age, race, and gender. Abbreviations: CKD, chronic kidney disease; DM, diabetes mellitus; HTN, hypertension. Af Am, African American; Native Am, Native American. (a) Urine albumin (b) Serum creatinine

Vol 1, CKD, Ch 213 Figure 2.6 Proportion of patients with (a) urine albumin & (b) serum creatinine testing by demographic characteristics, adjusted for age, race and gender, among Medicare patients aged 65+ WITH a diagnosis of CKD, 2013 Data Source: Special analyses, Medicare 5 percent sample. Models are adjusted for age, race, and gender. Abbreviations: CKD, chronic kidney disease; DM, diabetes mellitus; HTN, hypertension. Af Am, African American; Native Am, Native American. (a) Urine albumin (b) Serum creatinine

Vol 1, CKD, Ch 214 Table 2.6 Percent of patients with a physician visit in 2013 after a CKD diagnosis in 2012, among Medicare patients aged 65+ Data Source: Special analyses, Medicare 5 percent sample. Patients alive & eligible for all of CKD diagnosis is at date of first CKD claim in 2012; claims for physician visits were searched during the 12 months following that date. CKD diagnosis code of or higher represents CKD Stages 4-5. Abbreviation: CKD, chronic kidney disease. Af Am, African American. Any CKD diagnosis CKD diagnosis code of (Stage 3) CKD diagnosis code of (Stage 4) or higher Primary care CardiologistNephrologist Primary care CardiologistNephrologist Primary care CardiologistNephrologist Age Sex Male Female Race White Black/Af Am Other Overall

Vol 1, CKD, Ch 215 Table 2.7 Proportion of CKD patients in 2012 with physician visit (nephrologist, PCP, both and neither) in 2012, with lab testing in the following year (2013), by comorbidity Data Source: Special analyses, Medicare 5 percent sample. Patients alive & eligible for all of 2013 with a CKD diagnosis claim in Abbreviations: CKD, chronic kidney disease; DM, diabetes mellitus; HTN, hypertension; PCP, primary care physician. PCP OnlyNephrologist with and without PCPNeither Urine albumin testing Serum creatinine testing Urine albumin testing Serum creatinine testing Urine albumin testing Serum creatinine testing Nn%n% Nn%n%Nn%n% Overall 63, , , No DM, No HTN 4, , HTN, No DM 30,4493, , ,1445, , , , DM, No HTN 1, , DM & HTN 27,81010, , ,6409, , , ,