Related Experiment Video
Updated: Apr 23, 2026
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Validation study of medicare claims to identify older US adults with CKD using the Reasons for Geographic and Racial
Paul Muntner1, Orlando M Gutiérrez2, Hong Zhao1
1Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL.
Insights
Health care claims data can identify chronic kidney disease (CKD) patients, but may overrepresent high-risk individuals. Both claims-based and lab-based CKD definitions are linked to higher mortality and end-stage renal disease (ESRD).
Area of Science:
- Nephrology
- Epidemiology
- Health Services Research
Background:
- Health care claims data offer a potentially cost-effective method for studying chronic kidney disease (CKD).
- The accuracy of claims data in identifying CKD compared to research study definitions needs evaluation.
Purpose of the Study:
- To compare the characteristics and outcomes of individuals with CKD identified through laboratory measurements versus health care claims data.
- To assess the utility of Medicare claims data for identifying CKD and its association with mortality and end-stage renal disease (ESRD).
Main Methods:
- A prospective cohort study involving 6,982 participants from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study with Medicare fee-for-service coverage.
- CKD was defined using both research study criteria (CKDREGARDS: eGFR < 60mL/min/1.73m² or albumin-creatinine ratio > 30mg/g) and a Medicare claims-based algorithm (CKDMedicare) applied retrospectively.
- Comparison of participant characteristics, mortality, and ESRD incidence rates between individuals identified with CKD by each method.
Main Results:
- Overall, 32% of participants met the CKDREGARDS definition, while only 6% met the CKDMedicare definition.
- CKDMedicare demonstrated a sensitivity of 15.5% and specificity of 97.7% for identifying CKDREGARDS.
- Both CKDMedicare and CKDREGARDS were associated with significantly higher rates of mortality and ESRD incidence compared to individuals without CKD. Participants identified via claims data (CKDMedicare) exhibited higher mortality and ESRD rates than those identified solely by research criteria.
Conclusions:
- While CKD identified through either claims data or research measurements is associated with adverse outcomes, claims data may identify a higher-risk subgroup.
- The findings suggest that CKD identified in claims data represents a select, high-risk population, necessitating careful interpretation in epidemiological studies.
- Further research is needed to refine claims-based algorithms for CKD detection and to understand the clinical implications of discrepancies between claims and laboratory-based definitions.
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.
More Related Videos
Related Concept Videos
01:28Drug Dosing in Renal Diseases: Estimation of Glomerular Filtration Rate Based on Serum Creatinine Concentration
01:18Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion
01:28Chronic Kidney Disease III: Interprofessional Care
01:25Chronic Kidney Disease I: Introduction
01:18Chronic Kidney Disease IV: Nursing Management
01:17Factors Affecting Renal Clearance: Renal Impairment
One condition associated with renal failure is uremia. Uremia is characterized by impaired glomerular filtration and fluid accumulation in the body. This condition hinders the renal clearance of drugs, resulting in drug accumulation and potential...