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Kidney Week

Abstract: PO0513

Variation in Kidney Failure Risk Across Health Organizations Among Adults with CKD in Nephrology Ambulatory Care

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Chu, Chi D., University of California San Francisco, San Francisco, California, United States
  • Powe, Neil R., University of California San Francisco, San Francisco, California, United States
  • Shlipak, Michael, University of California San Francisco, San Francisco, California, United States
  • Scherzer, Rebecca, University of California San Francisco, San Francisco, California, United States
  • Tummalapalli, Sri Lekha, University of California San Francisco, San Francisco, California, United States
  • Estrella, Michelle M., University of California San Francisco, San Francisco, California, United States
  • Tuot, Delphine S., University of California San Francisco, San Francisco, California, United States
Background

Since most adults with chronic kidney disease (CKD) have low risk for end-stage kidney disease (ESKD) progression, subspecialty nephrology care should focus on patients at highest risk of progression. To optimize utilization of nephrology care, a threshold of 3% risk of ESKD at 5 years based on the Kidney Failure Risk Equation (KFRE) has been proposed for nephrology referral. To understand how application of this threshold in practice could impact CKD care delivery and subspecialty referral, we examined variation in 5-year ESKD risk distributions of patients in nephrology ambulatory care across U.S. healthcare organizations.

Methods

In 22 healthcare organizations, we identified patients age ≥18 years, with eGFR <60 ml/min/m2 and concurrently measured urine albumin/creatinine ratio, who had an ambulatory encounter with a nephrologist from 1/1/2017-12/31/2018 using the OptumLabs® Data Warehouse, a longitudinal, real-world data asset with de-identified administrative claims and electronic health record data. We compared the distribution of patient-derived KFRE 5-year risk across healthcare organizations with ≥500 patients in nephrology care.

Results

Among 45,145 patients with CKD in nephrology care, the overall median 5-year ESKD risk was 2.4%. However, between organizations, the median 5-year ESKD risk varied widely, ranging from 0.8% to 6.7% (Figure). 54.5% of patients were below the 3% recommended referral threshold risk of ESKD.

Conclusion

There is substantial heterogeneity of ESKD risk across healthcare organizations in the population receiving ambulatory nephrology care. A greater understanding of the patient population and delivery system characteristics is needed to explain this heterogeneity, and associated health outcomes could inform recommended risk thresholds for referral and ongoing nephrology care.

Funding

  • NIDDK Support