1. Chapter 2: Identification and Care of Patients With CKD 2014 ANNUAL DATA REPORT VOLUME 1: CHRONIC KIDNEY DISEASE

2. Table A. ICD-9-CM Codes Vol 1, CKD, Ch 22 Table A. ICD-9-CM Codes 585.1Chronic kidney disease, Stage 1 585.2Chronic kidney disease, Stage 2 (mild) 585.3Chronic kidney disease, Stage 3 (moderate) 585.4Chronic kidney disease, Stage 4 (severe) 585.5 Chronic kidney disease, Stage 5 (excludes 585.6: Stage 5, requiring chronic dialysis a ) CKD unspecified identified by multiple codes including 585.9, 250.4x, 403.9xm & others. CKD stage estimates are from a single measurement. For clinical case definition, abnormalities should be present ≥ 3 months. a In USRDS analyses, patients with ICD-9-CM code 585.6 & with no ESRD 2728 form or other indication of end-stage renal disease (ESRD) are considered to have code 585.5. See the CKD Analytical Methods chapter for details.

3. Data Source: Medicare 5 percent sample. Period prevalent patients, 2012, without ESRD, age 65 or older (Medicare). Abbreviations: CHF, congestive heart failure; CKD, chronic kidney disease; CVA, cerebrovascular accident; DM, diabetes mellitus. vol 1 Table 2.1 Prevalence of coded DM, CKD, CHF & CVA among Medicare patients age 65+, 2012 Vol 1, CKD, Ch 23 Medicare 5% SampleDistribution All1,230,285100% Total CHF112,3169.1 Total DM299,05224.3 Total CKD127,94110.4 Total CVA107,0268.7 DM & CHF21,4291.7 DM & CKD33,3922.7 DM & CVA20,1431.6 CHF & CKD12,8291.0 CHF & CVA8,4710.7 CKD & CVA7,3120.6 CHF & DM & CVA5,8180.5 CKD & DM & CVA6,6260.5 CKD & CHF & CVA4,3290.4 DM & CHF & CKD15,2731.2 DM & CHF & CKD & CVA6,1480.5 No DM, CKD, CHF & CVA770,06262.6

4. Data Source: Medicare 5 percent sample. Period prevalent patients, 2012, without ESRD, age 65 or older (Medicare). Abbreviations: CHF, congestive heart failure; DM, diabetes mellitus; HTN, hypertension. vol 1 Table 2.2 Characteristics of all patients, characteristics of CKD patients among Medicare patients age 65+, 2012 Vol 1, CKD, Ch 24 OverallPatients with CKD N Distribution of Characteristics (%) N All 1,230,285100 127,941100 65-74 654,86053.2 47,13936.8 75-84 403,49432.8 51,57740.3 85+ 171,93113.9 29,22522.8 Male 522,68442.5 60,19447.0 Female 707,60157.5 67,74752.9 White 1,064,64786.5 106,35983.1 Black/African Am 93,1957.6 14,09111.1 Native Am 4,9160.4 5360.4 Asian 22,9611.9 2,5682.1 Other 40,1933.3 4,1143.2 Unknown 4,3730.4 2730.2 DM 299,05024.3 61,43948.1 HTN 751,55061.1 118,12992.3 CHF 112,3169.1 38,57930.1 Cancer 127,97910.4 22,71217.7

5. Data Source: Medicare 5 percent sample. Period prevalent patients, 2012, without ESRD, age 65 or older (Medicare). Adjustments included are age, gender, race, and comorbidities. Abbreviations: DM, diabetes mellitus; HTN, hypertension; CVD, cardiovascular disease. CVD is defined as either one of the following comorbidities being true: cerebrovascular accident, peripheral vascular disease, atherosclerotic heart disease, congestive heart failure, dysrhythmia or other cardiac comorbidities. a Not applicable. vol 1 Table 2.3 Prevalence of CKD, and adjusted odds ratios of CKD among Medicare patients age 65+, 2012 Vol 1, CKD, Ch 25 Prevalence of CKD (% of overall) Adjusted Odds Ratios of CKD Overall10.4-a-a 65-747.2Ref. 75-8412.81.4 85+17.01.8 Male11.5Ref. Female9.60.8 White9.9Ref. Black/African Am15.11.4 Native Am10.91.1 Asian11.21.1 Other/Unknown10.20.9 DM20.52.1 HTN15.73.7 CVD18.42.3

6. Data Source: Medicare 5 percent sample. See Table A at the beginning of this chapter for a description of ICD-9-CM codes and CKD stages. vol 1 Figure 2.1 Temporal trends in CKD prevalence, overall and by CKD stage, among Medicare patients age 65+, 2000-2012 Vol 1, CKD, Ch 26

7. 7 Data Source: Medicare 5 percent sample. vol 1 Figure 2.2 Temporal trends in CKD prevalence by race among Medicare patients age 65+, 2000-2012

8. 8 Data Source: Medicare patients from the 5 percent sample, age 65 or older alive & eligible for all of 2012 and NHANES 2011-2012 participants, age 65 or older. CKD claims as well as other diseases identified in 2012. Abbreviations: 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. vol 1 Table 2.4 Percent of patients with CKD by demographic characteristics, among patients overall and with DM, HTN, or CVD, in NHANES (2011-2012) and Medicare (2012) datasets Vol 1, CKD, Ch 2 OverallDM (No HTN)HTN (No DM)Any CVD NHANESMedicareNHANESMedicareNHANESMedicareNHANES a Medicare b 65-7426.47.27.59.331.412.440.921.1 75-7950.412.8 * 12.645.417.766.725.8 80+65.217 * 15.367.224.080.529.8 White38.39.924.911.344.517.355.624.5 Black/ African Am49.915.1 * 11.946.621.468.335.2 Native Am-10.9-9.9-16.3-27.5 Asian-11.2-12.7-16.9-29.4 Other/Unk42.410.218.311.547.015.570.127.2 Male37.911.529.512.441.719.844.326.8 Female41.39.620.710.247.215.975.924.3 All39.710.426.611.344.917.558.525.4

9. 9 Data Source: Medicare patients from the 5 percent sample, age 65 or older with Part A & B coverage in the prior year. Tests tracked during each year. Abbreviations: DM, diabetes mellitus; HTN, hypertension. vol 1 Figure 2.3 Unadjusted cumulative probability for urine albumin & serum creatinine testing, among Medicare patients age 65+ WITHOUT a diagnosis of CKD, 2000-2012 Vol 1, CKD, Ch 2 (A) Urine albumin

10. 10 Data Source: Medicare patients from the 5 percent sample, age 65 or older with Part A & B coverage in the prior year. Tests tracked during each year. Abbreviations: DM, diabetes mellitus; HTN, hypertension. vol 1 Figure 2.3 Unadjusted cumulative probability for urine albumin & serum creatinine testing, among Medicare patients age 65+ WITHOUT a diagnosis of CKD, 2000-2012 Vol 1, CKD, Ch 2 (B) Serum creatinine

11. 11 Data Source: Medicare patients from the 5 percent sample, age 65 or older with Part A & B coverage in the prior year. Tests tracked during each year. Abbreviations: DM, diabetes mellitus; HTN, hypertension. vol 1 Figure 2.4 Unadjusted cumulative probability for urine albumin & serum creatinine testing, among Medicare patients age 65+ WITH a diagnosis of CKD, 2000-2012 Vol 1, CKD, Ch 2 (A) Urine albumin

12. 12 Data Source: Medicare patients from the 5 percent sample, age 65 or older with Part A & B coverage in the prior year. Tests tracked during each year. Abbreviations: DM, diabetes mellitus; HTN, hypertension. vol 1 Figure 2.4 Unadjusted cumulative probability for urine albumin & serum creatinine testing, among Medicare patients age 65+ WITH a diagnosis of CKD, 2000-2012 Vol 1, CKD, Ch 2 (B) Serum creatinine

13. 13 Data Source: Medicare 5 percent sample. Models are adjusted for age, race, and gender. Abbreviations: DM, diabetes mellitus; HTN, hypertension. vol 1 Figure 2.5 Adjusted cumulative probability of urine albumin (a) & serum creatinine (b) testing by demographic characteristics, among Medicare patients age 65+ WITHOUT a diagnosis of CKD, 2012 Vol 1, CKD, Ch 2 (A) Urine albumin

14. 14 Data Source: Medicare 5 percent sample. Models are adjusted for age, race, and gender. Abbreviations: DM, diabetes mellitus; HTN, hypertension. vol 1 Figure 2.5 Adjusted cumulative probability of urine albumin (a) & serum creatinine (b) testing by demographic characteristics, among Medicare patients age 65+ WITHOUT a diagnosis of CKD, 2012 Vol 1, CKD, Ch 2 (B) Serum creatinine

15. 15 Data Source: Medicare 5 percent sample. Models are adjusted for age, race and gender. Abbreviations: DM, diabetes mellitus; HTN, hypertension. vol 1 Figure 2.6 Adjusted cumulative probability of urine albumin (a) & serum creatinine (b) testing by demographic characteristics, among Medicare patients age 65+ WITH a diagnosis of CKD, 2012 Vol 1, CKD, Ch 2 (A) Urine albumin

16. 16 Data Source: Medicare 5 percent sample. Models are adjusted for age, race and gender. Abbreviations: DM, diabetes mellitus; HTN, hypertension. vol 1 Figure 2.6 Adjusted cumulative probability of urine albumin (a) & serum creatinine (b) testing by demographic characteristics, among Medicare patients age 65+ WITH a diagnosis of CKD, 2012 Vol 1, CKD, Ch 2 (B) Serum creatinine

17. 17 Data Source: Medicare 5 percent sample. Patients alive & eligible all of 2011. CKD diagnosis is at date of first CKD claim in 2011; claims for physician visits were searched during the 12 months following that date. CKD diagnosis code of 585.3 or higher represents CKD Stages 3-5. vol 1 Table 2.5 Cumulative probability of a physician visit at month 12 after CKD diagnosis in 2011 among Medicare patients age 65+ Vol 1, CKD, Ch 2 Any CKD DiagnosisCKD Diagnosis Code of 585.3 or Higher Primary CareCardiologistNephrologistPrimary CareCardiologistNephrologist 65-740.880.540.310.890.550.56 75-840.900.610.290.900.620.51 85+0.900.60.220.910.610.39 Male0.900.550.270.910.560.48 Female0.880.620.290.890.640.52 White0.890.590.280.900.600.49 Black/African Am0.890.560.330.890.570.55 Other0.880.540.290.880.550.49 Overall0.910.620.310.920.640.55