TY - JOUR
T1 - Estimating prevalence of CKD stages 3-5 using health system data
AU - Shahinian, Vahakn B.
AU - Hedgeman, Elizabeth
AU - Gillespie, Brenda W.
AU - Young, Eric W.
AU - Robinson, Bruce
AU - Hsu, Chi Yuan
AU - Plantinga, Laura C.
AU - Burrows, Nilka Ríos
AU - Eggers, Paul
AU - Saydah, Sharon
AU - Powe, Neil R.
AU - Saran, Rajiv
N1 - Funding Information:
Support: This work is funded by the Centers for Disease Control and Prevention (CDC) , grant 1U58DP003836 for the project titled “Establishing a Surveillance System for Chronic Kidney Disease.” This material is the result of work partially supported with resources and the use of facilities at the VA Ann Arbor Healthcare System. Publication and report contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC, the VA, or the US Government.
PY - 2013/6
Y1 - 2013/6
N2 - Background: The feasibility of using health system data to estimate prevalence of chronic kidney disease (CKD) stages 3-5 was explored. Study Design: Cohort study. Setting & Participants: A 5% national random sample of patients from the Veterans Affairs (VA) health care system, enrollees in a managed care plan in Michigan (M-CARE), and participants from the 2005-2006 National Health and Nutrition Examination Survey (NHANES). Predictor: Observed CKD prevalence estimates in the health system population were calculated as patients with an available outpatient serum creatinine measurement with estimated glomerular filtration rate <60 mL/min/1.73 m2, among those with at least one outpatient visit during the year. Outcomes & Measurements: A logistic regression model was fitted using data from the 2005-2006 NHANES to predict CKD prevalence in those untested for serum creatinine in the health system population, adjusted for demographics and comorbid conditions. Model results then were combined with the observed prevalence in tested patients to derive an overall predicted prevalence of CKD within the health systems. Results: Patients in the VA system were older, had more comorbid conditions, and were more likely to be tested for serum creatinine than those in the M-CARE system. Observed prevalences of CKD stages 3-5 were 15.6% and 0.9% in the VA and M-CARE systems, respectively. Using data from NHANES, the overall predicted prevalences of CKD were 20.4% and 1.6% in the VA and M-CARE systems, respectively. Limitations: Health system data quality was limited by missing data for laboratory results and race. A single estimated glomerular filtration rate value was used to define CKD, rather than persistence over 3 months. Conclusions: Estimation of CKD prevalence within health care systems is feasible, but discrepancies between observed and predicted prevalences suggest that this approach is dependent on data availability and quality of information for comorbid conditions, as well as the frequency of testing for CKD in the health care system.
AB - Background: The feasibility of using health system data to estimate prevalence of chronic kidney disease (CKD) stages 3-5 was explored. Study Design: Cohort study. Setting & Participants: A 5% national random sample of patients from the Veterans Affairs (VA) health care system, enrollees in a managed care plan in Michigan (M-CARE), and participants from the 2005-2006 National Health and Nutrition Examination Survey (NHANES). Predictor: Observed CKD prevalence estimates in the health system population were calculated as patients with an available outpatient serum creatinine measurement with estimated glomerular filtration rate <60 mL/min/1.73 m2, among those with at least one outpatient visit during the year. Outcomes & Measurements: A logistic regression model was fitted using data from the 2005-2006 NHANES to predict CKD prevalence in those untested for serum creatinine in the health system population, adjusted for demographics and comorbid conditions. Model results then were combined with the observed prevalence in tested patients to derive an overall predicted prevalence of CKD within the health systems. Results: Patients in the VA system were older, had more comorbid conditions, and were more likely to be tested for serum creatinine than those in the M-CARE system. Observed prevalences of CKD stages 3-5 were 15.6% and 0.9% in the VA and M-CARE systems, respectively. Using data from NHANES, the overall predicted prevalences of CKD were 20.4% and 1.6% in the VA and M-CARE systems, respectively. Limitations: Health system data quality was limited by missing data for laboratory results and race. A single estimated glomerular filtration rate value was used to define CKD, rather than persistence over 3 months. Conclusions: Estimation of CKD prevalence within health care systems is feasible, but discrepancies between observed and predicted prevalences suggest that this approach is dependent on data availability and quality of information for comorbid conditions, as well as the frequency of testing for CKD in the health care system.
KW - Chronic kidney disease
KW - epidemiology
KW - prevalence
KW - surveillance
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U2 - 10.1053/j.ajkd.2013.01.018
DO - 10.1053/j.ajkd.2013.01.018
M3 - Article
C2 - 23489675
AN - SCOPUS:84877921515
SN - 0272-6386
VL - 61
SP - 930
EP - 938
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 6
ER -