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Real-World Diagnostic Coding and Biomarker Testing for CKD Across Diabetes, Hypertension, and Cancer: A Multisite
Susan Ziolkowski1, Sam Patnoe2, Hannah Morgan-Cooper3
1Stanford University, Department of Medicine, Division of Nephrology, Palo Alto, CA.
Background:
The increasing prevalence of CKD necessitates standardized assessment of kidney function across various healthcare sites.1 Patients at risk, particularly those with diabetes, hypertension, or cancer, frequently do not receive recommended laboratory monitoring.2,3 This study assesses guideline recommended testing among various medical centers using the Observational Medical Outcomes Partnership (OMOP) common data model (CDM). The objectives are to report methodologies for extracting relevant measurements within OMOP and assess the frequency of specific biomarker evaluations and diagnosis codes in select cohorts.
Methods:
Retrospective cohort study of adult patients at 6 medical centers throughout the U.S. with a healthcare encounter to determine the frequency of diagnosis codes and biomarker measurements [eGFR, urine albumin-creatinine ratio (UACR), cystatin C, and aldosterone levels] among patients with relevant risk factors and probable CKD (sustained eGFR < 60 ml/min/1.73m2).
Results:
Among 9,212,799 patients with medical visits in 2024, 3% had a documented diagnosis of CKD, while 8% and 17% had a diagnosis of diabetes or hypertension, respectively. Also in 2024, only 47% of patients with probable CKD had a diagnosis code for CKD. Of the patients with diagnosed and probable CKD by eGFR, 25% had an UACR in 2024. Only 30% of patients with a diagnosis of diabetes, and 14% of patients with a diagnosis of hypertension had an UACR and eGFR in 2024. From 2021-2024, Cystatin C values were more common in patients with cancer compared to patients without cancer (1% vs 0.5%). The highest frequency of aldosterone testing (7%) was observed in patients with a diagnosis code for hypertension, serum potassium level <3 meq/L, eGFR> 60 ml/min/1.73m2, and albuminuria.
Conclusions:
This study demonstrates low frequency of guideline-recommended kidney health assessments and CKD diagnosis across multiple U.S. medical centers, including albuminuria, cystatin C, and aldosterone testing.