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Chronic Kidney Disease, Diabetes, and Quality Metrics

The Stats Are Bad, but the News Is Promising

Chronic kidney disease (CKD) has been one of the top 10 causes of death in the United States for more than a decade; one in three American adults are at risk for CKD. Until recently, CKD has received little attention. Diabetes is the leading driver of CKD, and most cases are preventable with good control. Even when not preventable, with appropriate interventions in the initial stages of CKD, progression to end-stage renal disease (ESRD) can be delayed by years.

The Impact if Ignored

ESRD is treated by hemodialysis or kidney transplant, both expensive options with significant impact on patients’ quality of life. Surprisingly, 9 of 10 (90%) patients with CKD are unaware of their diagnosis; further, 4 of 10 (40%) with severe CKD are unaware of their diagnosis. In some cases, this is because physicians do not inform their patients of the diagnosis, not wanting to alarm them. In many others, however, the diagnosis has not been made due to incomplete or inadequate screening.

What Can Be Done:

1. Screen Appropriately

Optimal screening for CKD involves two tests: the estimated glomerular filtration rate (eGFR) and an assessment of protein excretion in the urine, the urinary albumin-creatinine ratio (uACR). The National Committee for Quality Assurance (NCQA), working closely with the National Kidney Foundation (NKF), developed a Kidney Health Evaluation measure. In 2020, the Health Effectiveness Data and Information Set (HEDIS), one of healthcare’s most widely used performance improvement tools, added annual screening of patients with diabetes (both type 1 and type 2) with both tests, the eGFR and the uACR, as one of their performance measures. Medicare Advantage and Part D plans are now measured on this through the STAR ratings. However, despite this, only about 50% of patients with diabetes are routinely getting both tests. These two test results can be plotted on the Kidney Disease: Improving Global Outcomes (KDIGO) risk assessment chart shown below, and patients can be staged appropriately.


2. Inform and Educate Patients

Patients should be informed of their diagnosis and the consequences of CKD so that they might be inspired and empowered to modify their behavior (eg, stop smoking, control their diabetes and blood pressure, be more adherent with their medications, avoid nonsteroidal inflammatory drugs [NSAIDs], etc).

3. Treat Appropriately

Physicians should treat patients with optimal medical therapies (eg, angiotensin-converting enzyme [ACE] inhibitors, angiotensin receptor blockers [ARBs], sodium-glucose cotransporter-2 [SGLT2] inhibitors, etc) to slow the progression of CKD.

I am hosting a 30-minute online conversation (February 21, 3:00-3:30 pm EST) about obstacles to effective screening and practical solutions to overcome these barriers. If you’d like to join the conversation, register here. (Space is limited.)

QC-Health® Is Helping Start a Groundswell Movement™ Around This Important Topic

A Groundswell Movement is a series of collaborations with healthcare stakeholders to change behavior in the way chronic disease patient populations are identified and treated. We are collaborating with Aventria Health Group (a secondary provider–focused agency working with Pharma, biotech, and medical devices) and Relentless Health Value™ podcast (focused on healthcare influencers) to impact CKD outcomes. Information about the CKD Groundswell Movement initiative

For more information, please email us at info@qc-health.org.


John F. Rodis, MD, MBA, FACHE, is the independent benefit director for QC-Health®, former president and CEO of Saint Francis Hospital, member of Trinity Health of New England, and founder and president of Arista Health, LLC, a healthcare consulting company whose mission is to drive quality, safety, and patient experience and reduce risk in hospitals and health systems. He served as president of Saint Francis Hospital from 2015 to 2020, the eighth leader of Saint Francis and the first physician to serve as president since its founding in 1897.

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