Abstract: SA-PO869
Screening and Recognition of CKD in Primary Care Clinics in the VA Health Care System and Its Impact on Delivery of Care
Session Information
- CKD: Socioeconomic Context and Mobile Apps
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Bansal, Shweta, University of Texas Health at San Antonio, San Antonio, Texas, United States
- Mader, Michael J., South Texas Veterans Health Care System, San Antonio, Texas, United States
Background
The successful implementation of interventions targeted to improve kidney disease outcomes requires early identification of CKD. Early identification involves screening at-risk population as well as recognizing CKD. We determined CKD screening and recognition rate in at-risk veterans enrolled in Vertically Integrated Service Network (VISN) 17, and evaluated the impact of CKD awareness on processes of care.
Methods
We interrogated VISN 17 corporate Data Warehouse for Veterans seen at least twice in primary clinics with ICD-9 codes for hypertension (HTN) and diabetes (DM). The final cohort of 220,229 subjects (55.6% HTN, 6% diabetes and 38.4% both) was examined for serum creatinine/eGFR reported at least twice 90 days apart, urine protein and ICD-9 for CKD. Presence of CKD was defined as eGFR <60ml/min at least twice 90 days apart and/or urine albumin creatinine ratio (uACR) of >30 mg/g. BP readings from last two visits were averaged to evaluate HTN control. Prescription rate for statins and non-steroidal anti-inflammatory agents (NSAIDs) were assessed.
Results
Overall, 173,966 (79%) patients had one or other screening procedure done. Patients with isolated hypertension were less likely to have any screening procedure (72.8%) as compared to DM (81.1%) or both conditions (87.6%). Only 40.3% of total patients had urine protein in the chart, worse in HTN (18.3%) compared to DM (62.6%) or both (68.5%). Of 173,966 patients, 73,965 (42.5%) had lab evidence of CKD. However, only 19,317 (26.1%) did have a documented ICD-9 CKD diagnosis. Many of these unrecognized CKD patients (30.5%) had CKD based on uACR criteria. There was no clinically significant difference between recognized vs. unrecognized CKD groups in terms of age, sex and race. Moreover, blood pressure control and statin prescription rate were also not different. Of note, patients with BP >140/90 mmHg consistently had high rates of uACR >300 mg/g irrespective of CKD documentation. Diuretics prescription was higher (66.7% vs 58%) and NSAIDs was lower (11.4% vs. 22.9%) in documented vs undocumented CKD groups.
Conclusion
While overall CKD screening rate was 79%, identification of albuminuria was suboptimal and despite screening procedures the recognition of CKD was low in VISN 17 population with HTN and DM. Early awareness of CKD may improve processes of care.
Funding
- Veterans Affairs Support