Kidney Week

Abstract: TH-PO1049

US Veterans with Stage 3-5 Non-Dialysis Dependent CKD Are More Likely to See a Cardiologist Than a Nephrologist

Session Information

• CKD: Epidemiology, Risk Factors, Prevention - I
  October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 1901 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Markossian, Talar, Loyola University Chicago, Maywood, Illinois, United States

Talar Markossian,

• Kramer, Holly J., Loyola University Chicago, Maywood, Illinois, United States

Holly J. Kramer,

• Leehey, David J., Hines VA Medical Center, Maywood, Illinois, United States

David J. Leehey,

• Pacold, Ivan M., Hines VA Medical Center, Maywood, Illinois, United States

Ivan M. Pacold,

• Burge, Nick, Hines VA Medical Center, Maywood, Illinois, United States

Nick Burge,

• Stroupe, Kevin, Hines VA Medical Center, Maywood, Illinois, United States

Kevin Stroupe,

Background

Nephrology care has been shown to improve outcomes and delay or even prevent end-stage renal disease (ESRD) in adults with established chronic kidney disease (CKD) but many never see a nephrologist. We examined the percentage of U.S. Veterans with -5 non-dialysis dependent CKD (CKD-ND) with at least one nephrology clinic encounter during calendar year 2015. We also examined the percentage of adults with CKD-ND with at least one cardiology clinic encounter during calendar year 2015 and examined whether referal patterns for nephrology or cardiology differed by race.

Methods

We used data from the VA Corporate Data Warehouse which includes demographics, inpatient and outpatient encounter diagnosis and procedure codes [International Classification of Diseases, Ninth/Tenth Revision, Clinical Modification (ICD9/10-CM) and Current Procedural Terminology (CPT) codes], and patient labs. Since a percentage of Veterans receive their care from non-VA sources, we linked data from the Center for Medicare & Medicaid Services administrative databases to capture non-VA health care use. CKD status was based on presence of at least two estimated glomerular filtration rate (eGFR) values < 60 ml/min/1.73 m² in outpatient laboratory data spaced 90+ days apart.

Results

There were 242,865 Veterans age ≧50 with at least two eGFR<60 ml/min/1.73 m² spaced 90+ days apart during calendar year 2014 with no history of dialysis or transplantation. Mean age was 76.4 years (standard deviation 9.6) and 96.7% were male and most were white with 14.9% reporting black race. In this group with stage 3-5 CKD-ND, 16.6% saw a VA nephrologist and 6.1% saw a Medicare reimbursed nephrologist while 21.4% saw a VA cardiologist and 19.5% saw a Medicare reimbursed cardiologist. Compared to whites with stage 3-5 CKD-ND, black Veterans with stage 3-5 CKD-ND were more likely to see a VA or Medicare reimbursed nephrologist (31.8% vs. 20.1%, p<0.001) but less likely to see a VA or Medicare reimbursed cardiologist (32.3% vs. 38.7%; P < 0.001).

Conclusion

Veterans with stage 3-5 CKD-ND are almost twice as likely to receive cardiology care than nephrology care although this differs somewhat by race. Increasing nephrology referral rates for patients with CKD-ND should be a priority for health systems in order to delay or prevent ESRD.

Funding

• NIDDK Support