Kidney Health Evaluation

Measure Specification

Chronic Kidney Disease (CKD) is a major driver of morbidity, mortality and high healthcare costs in the United States. Currently, 37 million American adults have CKD and millions of others are at increased risk, with an estimated population prevalence growing to nearly 17% among Americans aged 30 years and older by the year 2030. Total Medicare spending in 2016 on both CKD and End-Stage Renal Disease (ESRD) was over $114 billion, comprising 23% of total Medicare fee-for-service spending overall with costs increasing exponentially with advancing CKD.

In the US from 2002-2016, the burden of CKD, defined as years of life lost, years living with disability, disability-adjusted life years, and deaths, outpaced changes in the burden of disease for other conditions. Patients with CKD are readmitted to the hospital more frequently than those without diagnosed CKD. CKD is the 9th leading cause of death in the US and is the fastest growing non-communicable disease in terms of in burden largely due to death.

This public health issue is driven largely by the impact of diabetes— the most common comorbid risk factor for CKD. The intent of this process measure is to improve rates of guideline-concordant kidney health evaluation in patients with diabetes to more consistently identify and potentially treat or delay progression of CKD in this high-risk population.

Annual kidney health evaluation in patients with diabetes to determine risk of CKD using eGFR and uACR is recommended by clinical practice guidelines and has been a focus of various local and national health care quality improvement initiatives, including Healthy People 2030. However, performance of these tests in patients with diabetes remains low, with rates that vary across Medicare (41.

8%) and private insurers (49.0%). Low rates of detection of CKD in a population of patients with diabetes have been demonstrated to be associated with low patient awareness of their own kidney health status. Indeed, 90% of individuals with CKD are unaware of their condition due to under-recognition and under-diagnosis. Currently, an individual’s lifetime probability of developing CKD is relatively high, reaching 54% for someone currently aged 30-49 years.

Regular kidney health evaluations, utilizing both eGFR and uACR, provide an opportunity to improve identification and potential reversal of worsening kidney function, particularly in high risk populations, such as those with diabetes.

Annual kidney health evaluation using estimated glomerular filtration rate (eGFR) and urine albumin creatinine ratio (uACR) to determine risk of CKD in patients diagnosed with diabetes is recommended by clinical practice guidelines (ADA, 2023; NKF, 2007; NKF, 2012) and has been a focus of various local and national health care quality improvement initiatives, including Healthy People 2030 (United States Renal Data System, 2022).

However, performance of these tests in patients with diabetes remains low, with rates that vary across Medicare (41.8 percent) and private insurers (49.0 percent) (Saran et al., 2019). Low rates of detection of CKD in a population of patients with diabetes have been demonstrated to be associated with low patient awareness of their own kidney health status (Szczech et al.

, 2014). Regular kidney health evaluations, utilizing both eGFR and uACR, provide an opportunity to improve identification and potential reversal of worsening kidney function, particularly in high risk populations, such as those with diabetes. Kidney health evaluation in patients with diabetes, in accordance with clinical guidelines, leads to the identification of CKD patients and the potential treatment and delay of progression of CKD.

The following evidence statements are quoted from the referenced clinical guidelines: 1) At least annually, urinary albumin (e.g., spot urinary albumin-to-creatinine ratio) and estimated glomerular filtration rate should be assessed in people with type 1 diabetes with duration of ≥5 years and in all people with type 2 diabetes regardless of treatment.

(Evidence Grade = B) (American Diabetes Association, 2023) 2) Patients with diabetes should be screened annually for chronic kidney disease. Initial screening should commence: 5 years after the diagnosis of type 1 diabetes; (Evidence Grade = A) or from diagnosis of type 2 diabetes. (Evidence Grade = B) Screening should include measurements of urinary albumin-creatinine ratio (ACR) in a spot urine sample; (Evidence Grade = B) measurement of serum creatinine and estimation of GFR.

This measure contains one strata defined by a single submission criteria. This measure produces a single performance rate. For the purposes of MIPS implementation, this patient-process measure is submitted a minimum of once per patient for the performance period. The most advantageous quality data code will be used if the measure is submitted more than once.