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Abstract: FR-PO191

Monitoring Quality of Care for CKD in the United States

Session Information

Category: CKD (Non-Dialysis)

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


  • Fukuma, Shingo, Kyoto University, Kyoto, Japan
  • Han, Yun, University of Michigan, Ann Arbor, Michigan, United States
  • Steffick, Diane, University of Michigan, Ann Arbor, Michigan, United States
  • Bragg-Gresham, Jennifer L., University of Michigan, Ann Arbor, Michigan, United States
  • He, Kevin, Kidney Epidemiology and Cost Center, University of Michgian, Ann Arbor, Michigan, United States
  • Ikenoue, Tatsuyoshi, Kyoto University Graduate School of Medicine and Public Health, Kyoto, kyoto, Japan
  • Yamada, Yukari, Kyoto University, Kyoto, Japan
  • Norton, Edward C., University of Michigan, Ann Arbor, Michigan, United States
  • Ayanian, John Z., University of Michigan , Ann Arbor, Michigan, United States
  • Saran, Rajiv, University of Michigan , Ann Arbor, Michigan, United States

Monitoring quality of CKD care and understanding geographic variation in care quality are important for improving patient outcomes; however this topic has received limited attention. We examined quality of care measures for CKD and geographic variation in elderly Medicare beneficiaries in the United States.


We analyzed the 5% sample of the Medicare fee-for-service population linked with Part D medication claims data from 2007 to 2015. We selected elderly (≧65 years) patients with diagnosed CKD (by ICD-9 codes) and examined their care in repeated annual crossections. We assessed 4 key CKD quality indicators including urine albumin testing, renin-angiotensin (RAS) inhibitors use, not receiving (i.e., <14 days per month prescription) of non steroidal anti-inflammatory drugs (NSAIDs), and receiving nutritional consultation. Variation in these practices by age, sex, race, comorbidities (diabetes, hypertension and history of cardiovascular disease) and county of residence, were examined. A multivariate logistic model identified factors associated with urine albumin testing and RAS inhibitor use.


Of the total 2,162,085 elderly CKD patients, 43.1% were 80 years or older, 44.8% had diabetes, and 86.4% had hypertension. We observed steady increase in urine testing (from 21.5% in 2007 to 29.5% in 2015) and RAS inhibitor use (31.8% in 2007 to 40.6% in 2015) (each p for trend <0.01). During the same follow-up years, nutritional guidance was received in under 2%, but NSAIDs avoidance was observed in over 95%. County-level variation (Figure) in urine testing and RAS inhibitor use ranged widely from 0 to >50%, and increased over time. Age <80 years, diabetes, and hypertension, were associated with higher odds of urine testing and RAS inhibitor use.


Significant practice gaps and variations exist across the US for selected quality indicators of CKD care in older adults. More research into this area is vital as quality of care monitoring has potential to inform policy and practice improvements for this patient population..


  • NIDDK Support