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Abstract: PO0508

Prevalence of Coded and Uncoded CKD in the Military Health System

Session Information

Category: CKD (Non-Dialysis)

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

Authors

  • Norton, Jenna M., Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States
  • Grunwald, Lindsay, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States
  • Olsen, Cara H., Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States
  • Marks, Eric S., Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States
  • Koehlmoos, Tracey L., Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States
Background

Despite the substantial human and financial costs associated with chronic kidney disease (CKD) and its high prevalence in the general population, little is known about rates of CKD in the nearly 9.5 million beneficiaries of the Military Health System (MHS). Diagnostic codes lack adequate sensitivity and validity for identifying CKD using health system data. Using laboratory-data may enable a more accurate assessment of the burden of CKD in the MHS.

Methods

We identified all MHS beneficiaries aged 18 to 64 who received care through the MHS from October 1, 2015 to September 30, 2018. CKD was identified by ICD-10 code and/or a validated laboratory value-based electronic phenotype for CKD. CKD was considered coded if an ICD-10 code was present and uncoded if no ICD-10 code was present. Characteristics of the coded and uncoded CKD populations were compared using two-tailed t tests (continuous variables) and Pearson’s Chi Square test for independence (categorical variables).

Results

The total study population included 3,330,893 MHS beneficiaries. Of those, 105,504 (3.2%) were identified as having CKD. Of those with CKD, only 37% had an ICD-10 code for CKD. Compared to individuals with coded CKD, those with uncoded CKD were younger (average age 45 vs 52), more likely to be female, and more likely to be active duty, but less likely to be of Black race, to have diabetes or to have hypertension (p <.0001). Among those with test results recorded in the MHS, those with coded CKD had greater numbers of urine albumin, urine albumin-to-creatinine ratio, urine protein-to-creatinine ratio, serum creatine, and eGFR results (p <.0001).

Conclusion

Many MHS beneficiaries with laboratory values indicative of CKD were not coded for CKD, suggesting they may not be receiving appropriate management for this progressive and burdensome disease. Individuals with commonly recognized risk factors for CKD (e.g., older age, male sex, black race, diagnosed diabetes, diagnosed hypertension) were more likely to be coded for CKD, suggesting clinicians may be missing CKD in traditionally lower risk groups—despite available laboratory data to asses disease status.

Funding

  • Other U.S. Government Support