Chronic Kidney Disease Identification in a High-Risk Urban Population: Does Automated eGFR Reporting Make a Difference?

Abstract

Whether automated estimated glomerular filtration rate (eGFR) reporting for patients is associated with improved provider recognition of chronic kidney disease (CKD), as measured by diagnostic coding of CKD in those with laboratory evidence of the disease, has not been explored in a poor, ethnically diverse, highrisk urban patient population. A retrospective cohort of 237 adult patients (≥20 years) with incident CKD (≥1 eGFR ≥60 ml/min/1.73 m 2 , followed by ≥2 eGFRs G60 ml/min/1.73 m 2 ≥3 months apart)-pre-or postautomated eGFR reporting-was identified within the San Francisco Department of Public Health Community Health Network (January 2005-July 2009). Patients were considered coded if any ICD-9-CM diagnostic codes for CKD (585.x), other kidney disease (580.x-581.x, 586.x), or diabetes (250.4) or hypertension (403.x, 404.x) CKD were present in the medical record within 6 months of incident CKD. Multivariable logistic regression was used to obtain adjusted odds ratios (ORs) for CKD coding. We found that, pre-eGFR reporting, 42.5 % of incident CKD patients were coded for CKD. Female gender, increased age, and non-Black race were associated with lower serum creatinine and lower prevalence of coding but comparable eGFR. Prevalence of coding was not statistically significantly higher overall (49.6 %, P=0.27) or in subgroups after the institution of automated eGFR reporting. However, gaps in coding by age and gender were narrowed post-eGFR, even after adjustment for sociodemographic and clinical characteristics: 47.9 % of those G65 and 30.3 % of those ≥65 were coded pre-eGFR, compared to 49.0 % and 52.0 % post-eGFR (OR = 0.43 and 1.16); similarly, 53.2 % of males and 25.4 % of females were coded preeGFR compared to 52.8 % and 44.0 % post-eGFR (OR 0.28 vs. 0.64). Blacks were more likely to be coded in the post-eGFR period: OR=1.08 and 1.43 (P interaction 9 0.05). Automated eGFR reporting may help improve CKD recognition, but it is not sufficient to resolve underidentification of CKD by safety net providers.

Relationship Between Metabolic Syndrome Severity and Kidney Function as Related to Gender: A Population-Based Longitudinal Study

“…This may be in keeping with a prospective longterm study that found that high adiponectin is a novel independent predictor of CKD disease progression in men but not in women (Kollerits, Fliser, Heid, Ritz, & Kronenberg, 2007) and that adiponectin showed a strong positive correlation with age (Higashiura et al, 2004). This is consistent with previous studies that found that MetS is a significant determinant of kidney function in men (Tanaka, Shiohira, Uezu, Higa, & Iseki, 2006) and that female gender and increased age were associated with a lower progressive reduction of eGFR (Plantinga, Tuot, Grubbs, Hsu, & Powe, 2012). Our findings also echo the work of Eriksen and Ingebretsen (2006), who show that females have a slower progression of reduced kidney function.…”

Chronic Kidney Disease in an Electronic Health Record Problem List: Quality of Care, ESRD, and Mortality

“…20–23 Among a multi-specialty group practice of 15 health centers, about 25% of the 12,000 patients with CKD had it listed in the problem list. 22 In an urban setting with a high risk population nearly 50% of the 300 patients with CKD had ICD-9 coding documentation.…”

“…22 In an urban setting with a high risk population nearly 50% of the 300 patients with CKD had ICD-9 coding documentation. 23 Through chart review of nearly 900 patients with an eGFR < 60 being cared for in rural practices a study found less than 50% with documented CKD, even among those with high risk conditions such as hypertension and diabetes. 24 Similar to our finding of increased recognition with advanced CKD, a PCP practice based research network with nearly 35,000 CKD patients, found very low documentation of diagnosis among early CKD eGFR 45–59 (<10%), but higher documentation among CKD eGFR 30–44 (54%) and eGFR15-29 (54%).…”

Chronic kidney disease (CKD) treatment burden among low-income primary care patients

“…11,12 The treatment burden of CKD may be particularly difficult to manage for lowincome populations that also have a higher risk of developing CKD and its complications. 14,15 Compared to the general population, these groups are more likely to live in disadvantaged neighborhoods and experience limited access to health care resources, low educational opportunities, and chronic unemployment. 16 These social determinants of health have a deleterious impact on an individual's ability to manage a chronic illness that requires consistent self-monitoring, adherence to regular medical care, and dietary and lifestyle changes.…”