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Table 3 Performance on CKD Management Evidence-Based Quality Metrics captured by PHS CKD registry

From: Development of an electronic health record-based chronic kidney disease registry to promote population health management

N (%)

CKD Stage

3A (n = 32,962)

3B (n = 17,927)

4 (n = 5579)

5 (n = 1295)

5D (n = 2740)

Annual Testing a

 eGFR

26,725 (81.1)

14,622 (81.6)

4374 (78.4)

787 (60.8)

*

 Proteinuria

5734 (17.4)

4276 (23.9)

1738 (31.2)

240 (18.5)

*

BP controlb

    

*

 Yes

24,153 (73.3)

12,868 (71.8)

3708 (66.5)

660 (46.8)

*

 No

2784 (8.5)

1334 (7.4)

409 (8.7)

112 (8.7)

*

 Unknown

6025 (18.3)

3725 (20.8)

1462 (26.2)

577 (44.6)

*

ACE-I/ARBc

    

*

 Yes

13,766 (41.8)

8308 (46.3)

2292 (41.1)

409 (31.6)

*

 No

10,956 (33.3)

6869 (38.3)

2570 (46.1)

655 (50.6)

*

 N/A

8240 (25.0)

2750 (15.3)

717 (12.9)

231 (17.8)

*

Nephrotoxin Statusd

 Not on any renally unsafe medications

NC

NC

4286 (76.8)

1075 (83.0)

1986 (72.5)

 On potentially unsafe medication

NC

NC

929 (16.7)

199 (15.4)

489 (17.9)

 On renally unsafe medication (eGFR≤30)

NC

NC

364 (6.5)

21 (1.6)

14 (0.5)

Hepatitis B immunitye

 Immune by HBsAB

553 (1.7)

339 (1.9)

178 (3.2)

137 (10.6)

553 (20.2)

 Immunization received

1935 (5.9)

924 (5.2)

415 (7.4)

192 (14.8)

876 (32.0)

 Not immune by HBsAB

30,474 (92.5)

16,664 (93.0)

4986 (89.4)

966 (74.6)

1311 (47.9)

  1. Abbreviations: eGFR Estimated glomerular filtration rate, ACE-I Angiotensin converting enzyme inhibitor, ARB Angiotensin receptor blocker, HBsAB Hepatitis B surface antibody
  2. *Data not included due to lack of evidence-base for quality metrics in 5D patients
  3. N/A Not applicable as defined below
  4. NC Not calculated for CKD stage 3a and 3b, given lack of evidence-base for nephrotoxin avoidance in patients with eGFR > 30
  5. Definitions:
  6. aAnnual Testing indicates the proportion of patients who had at least one recorded value for each designated test within the past year
  7. bBlood pressure control: Patients who had the most recent recorded blood pressure < 140/90 mmHg or on maximal blood pressure medication therapy (defined as three anti-hypertensive agents at maximum dose, including diuretics were designated as “yes.” Those with no recorded blood pressure values at all or those with no blood pressure values recorded within the last year were designated as “unknown.” All others were designated as “no.”
  8. cACE-I/ARB: Patients were designated as “N/A”, not applicable, if they did not have hypertension, diabetes, or proteinuria, or if they did have last serum potassium > 5.0 meq/L, bilateral renal artery stenosis, documented nephrotoxic reaction to ACE-I/ARB, documented angioedema or swelling reaction to ACE-I/ARB, or were pregnant. Patients who were prescribed ACE-I or ARB were designated as “yes.” All other patients were designated as “no.”
  9. dNephrotoxic medication list was derived based on KDIGO 2012 guidelines,22 Whittaker et al. CJASN 201823 (initially preliminary data shared by this research group). “Renally unsafe medications” are medications that are contraindicated in patients with eGFR< 30 ml/min/1.73m2. “Potentially unsafe medications” are medications that may result in toxicity in those patients with <eGFR. Please see Additional file 3: Table S2 for the complete lists of both types of medications
  10. eHepatitis B immunity is defined as having received a HBV vaccine or having a HBsAB titer > 12 mIU/ml. If at least one of these conditions was not met, then patients were categorized as “Not immune by HBsAB.”
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BMC Nephrology

ISSN: 1471-2369

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