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Validation study of medicare claims to identify older US adults with CKD using the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study.
Am J Kidney Dis 2015; 65(2):249-58AJ

Abstract

BACKGROUND

Health care claims data may provide a cost-efficient approach for studying chronic kidney disease (CKD).

STUDY DESIGN

Prospective cohort study.

SETTING & PARTICIPANTS

We compared characteristics and outcomes for individuals with CKD defined using laboratory measurements versus claims data from 6,982 REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study participants who had Medicare fee-for-service coverage.

PREDICTORS

Presence of CKD as defined by both the REGARDS Study (CKDREGARDS) and Medicare data (CKDMedicare), presence of CKDREGARDS but not CKDMedicare, and presence of CKDMedicare but not CKDREGARDS, and absence of both CKDREGARDS and CKDMedicare.

OUTCOMES

Mortality and incident end-stage renal disease (ESRD).

MEASUREMENTS

The research study definition of CKD (CKDREGARDS) included estimated glomerular filtration rate (eGFR) < 60mL/min/1.73m(2) or albumin-creatinine ratio > 30mg/g at the REGARDS Study visit. CKD in Medicare (CKDMedicare) was identified during the 2 years before each participant's REGARDS visit using a claims-based algorithm.

RESULTS

Overall, 32% of participants had CKDREGARDS and 6% had CKDMedicare. Sensitivity, specificity, and positive and negative predictive values of CKDMedicare for identifying CKDREGARDS were 15.5% (95% CI, 14.0%-17.1%), 97.7% (95% CI, 97.2%-98.1%), 75.6% (95% CI, 71.4%-79.5%), and 71.5% (95% CI, 70.4%-72.6%), respectively. Mortality and ESRD incidence rates, expressed per 1,000 person-years, were higher for participants with versus without CKDMedicare (mortality: 72.5 [95% CI, 61.3-83.7] vs 33.3 [95% CI, 31.5-35.2]; ESRD: 16.4 [95% CI, 11.2-21.6] vs 1.3 [95% CI, 0.9-1.6]) and with versus without CKDREGARDS (mortality: 59.9 [95% CI, 55.4-64.4] vs 25.5 [95% CI, 23.6-27.4]; ESRD: 6.8 [95% CI, 5.4-8.3] vs 0.1 [95% CI, 0.0-0.3]). Among participants with CKDREGARDS, those with abdominal obesity, diabetes, anemia, lower eGFR, more outpatient visits, hospitalization, and a nephrologist visit in the 2 years before their REGARDS visit were more likely to have CKDMedicare.

LIMITATIONS

CKDREGARDS relied on eGFR and albuminuria assessed at a single visit.

CONCLUSIONS

CKD, whether defined in claims or through research study measurements, was associated with increased mortality and ESRD. However, individuals with CKD identified in claims may represent a select high-risk population.

Authors+Show Affiliations

Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL. Electronic address: pmuntner@uab.edu.Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL; Department of Medicine, University of Alabama at Birmingham, Birmingham, AL.Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL.National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA; Department of Endocrinology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL.Department of Medicine, University of Alabama at Birmingham, Birmingham, AL.Department of Epidemiology, Emory University, Atlanta, GA.Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL.Department of Healthcare Organization and Policy, University of Alabama at Birmingham, Birmingham, AL.Department of Medicine, University of Alabama at Birmingham, Birmingham, AL.Atlanta VA Medical Center, Atlanta, GA; Department of Medicine, Emory University, Atlanta, GA.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Validation Study

Language

eng

PubMed ID

25242367

Citation

Muntner, Paul, et al. "Validation Study of Medicare Claims to Identify Older US Adults With CKD Using the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 65, no. 2, 2015, pp. 249-58.
Muntner P, Gutiérrez OM, Zhao H, et al. Validation study of medicare claims to identify older US adults with CKD using the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study. Am J Kidney Dis. 2015;65(2):249-58.
Muntner, P., Gutiérrez, O. M., Zhao, H., Fox, C. S., Wright, N. C., Curtis, J. R., ... Bowling, C. B. (2015). Validation study of medicare claims to identify older US adults with CKD using the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 65(2), pp. 249-58. doi:10.1053/j.ajkd.2014.07.012.
Muntner P, et al. Validation Study of Medicare Claims to Identify Older US Adults With CKD Using the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study. Am J Kidney Dis. 2015;65(2):249-58. PubMed PMID: 25242367.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Validation study of medicare claims to identify older US adults with CKD using the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study. AU - Muntner,Paul, AU - Gutiérrez,Orlando M, AU - Zhao,Hong, AU - Fox,Caroline S, AU - Wright,Nicole C, AU - Curtis,Jeffrey R, AU - McClellan,William, AU - Wang,Henry, AU - Kilgore,Meredith, AU - Warnock,David G, AU - Bowling,C Barrett, Y1 - 2014/09/19/ PY - 2014/02/07/received PY - 2014/07/17/accepted PY - 2014/9/23/entrez PY - 2014/9/23/pubmed PY - 2015/3/21/medline KW - Chronic kidney disease (CKD) KW - albuminuria KW - claims-based algorithm KW - end-stage renal disease (ESRD) KW - estimated glomerular filtration rate (eGFR) KW - health care claims data KW - predictive value KW - sensitivity KW - specificity SP - 249 EP - 58 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am. J. Kidney Dis. VL - 65 IS - 2 N2 - BACKGROUND: Health care claims data may provide a cost-efficient approach for studying chronic kidney disease (CKD). STUDY DESIGN: Prospective cohort study. SETTING & PARTICIPANTS: We compared characteristics and outcomes for individuals with CKD defined using laboratory measurements versus claims data from 6,982 REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study participants who had Medicare fee-for-service coverage. PREDICTORS: Presence of CKD as defined by both the REGARDS Study (CKDREGARDS) and Medicare data (CKDMedicare), presence of CKDREGARDS but not CKDMedicare, and presence of CKDMedicare but not CKDREGARDS, and absence of both CKDREGARDS and CKDMedicare. OUTCOMES: Mortality and incident end-stage renal disease (ESRD). MEASUREMENTS: The research study definition of CKD (CKDREGARDS) included estimated glomerular filtration rate (eGFR) < 60mL/min/1.73m(2) or albumin-creatinine ratio > 30mg/g at the REGARDS Study visit. CKD in Medicare (CKDMedicare) was identified during the 2 years before each participant's REGARDS visit using a claims-based algorithm. RESULTS: Overall, 32% of participants had CKDREGARDS and 6% had CKDMedicare. Sensitivity, specificity, and positive and negative predictive values of CKDMedicare for identifying CKDREGARDS were 15.5% (95% CI, 14.0%-17.1%), 97.7% (95% CI, 97.2%-98.1%), 75.6% (95% CI, 71.4%-79.5%), and 71.5% (95% CI, 70.4%-72.6%), respectively. Mortality and ESRD incidence rates, expressed per 1,000 person-years, were higher for participants with versus without CKDMedicare (mortality: 72.5 [95% CI, 61.3-83.7] vs 33.3 [95% CI, 31.5-35.2]; ESRD: 16.4 [95% CI, 11.2-21.6] vs 1.3 [95% CI, 0.9-1.6]) and with versus without CKDREGARDS (mortality: 59.9 [95% CI, 55.4-64.4] vs 25.5 [95% CI, 23.6-27.4]; ESRD: 6.8 [95% CI, 5.4-8.3] vs 0.1 [95% CI, 0.0-0.3]). Among participants with CKDREGARDS, those with abdominal obesity, diabetes, anemia, lower eGFR, more outpatient visits, hospitalization, and a nephrologist visit in the 2 years before their REGARDS visit were more likely to have CKDMedicare. LIMITATIONS: CKDREGARDS relied on eGFR and albuminuria assessed at a single visit. CONCLUSIONS: CKD, whether defined in claims or through research study measurements, was associated with increased mortality and ESRD. However, individuals with CKD identified in claims may represent a select high-risk population. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/25242367/Validation_study_of_medicare_claims_to_identify_older_US_adults_with_CKD_using_the_Reasons_for_Geographic_and_Racial_Differences_in_Stroke__REGARDS__Study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(14)01082-8 DB - PRIME DP - Unbound Medicine ER -