Kidney Week

Abstract: PUB113

CKD Testing among Patients with Diabetes in the US Military Health System

Session Information

• Publication Only

Category: Diabetic Kidney Disease

• 702 Diabetic Kidney Disease: Clinical

Authors

• Nee, Robert, Walter Reed National Military Medical Center, Bethesda, Maryland, United States

Robert Nee, MD, FASN

• Oliver, James D., Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States

James D. Oliver, MD, PhD

• Marneweck, Hava, Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, United States

Hava Marneweck, MS

• Banaag, Amanda, Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, United States

Amanda Banaag, MPH

• Xu, Fang, Centers for Disease Control and Prevention, Atlanta, Georgia, United States

Fang Xu, PhD

• Koyama, Alain K., Centers for Disease Control and Prevention, Atlanta, Georgia, United States

Alain K. Koyama, PhD

• Miyamoto, Yoshihisa, Centers for Disease Control and Prevention, Atlanta, Georgia, United States

Yoshihisa Miyamoto, MD, PhD

• Pavkov, Meda E., Centers for Disease Control and Prevention, Atlanta, Georgia, United States

Meda E. Pavkov, MD, PhD

• Koehlmoos, Tracey L., Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States

Tracey L. Koehlmoos, PhD

Background

Despite guideline recommendations, annual chronic kidney disease (CKD) testing that includes both urine albumin-creatinine ratio (uACR) and estimated glomerular filtration rate (eGFR) remains low (<50%) among U.S. adults with diabetes mellitus (DM). As an integrated health care system with universal coverage, we hypothesized that CKD testing rates among DM adults in the Military Health System (MHS) would be higher than the overall national trend.

Methods

Using the MHS Data Repository (2016−2019), we analyzed the annual prevalence of non-pregnant DM adults with and without CKD based on ICD-10 codes who were tested for urine protein only (urine albumin, uACR, urine protein, urine protein-creatinine ratio [uPCR]); eGFR only; or both urine protein and eGFR. We also assessed race stratification and specialties of ordering providers.

Results

For 2019, 186,616 (6.2%) of 2,989,368 adults had DM (median age 60 [IQR 53−64] years; male 52.4%; White 32.3%, Black 17.4%, Asian American/Pacific Islander 4.9%, Native American/Alaskan Native 0.5%, Missing 30.3%; median eGFR = 79 [IQR 58−97] ml/min/1.73m², median uACR = 16.9 [IQR 6.6−56.6] mg/g). Sixty-one percent (61%) of DM+/CKD- and 70% of DM+/CKD+ were tested for both urine protein/eGFR (Fig). Racial categories were significantly associated with both urine protein/eGFR testing in the two cohorts in 2019 (p<0.0001). Among DM+/CKD- patients, 66% of urine protein and 55% of eGFR labs were ordered by primary care providers.

Conclusion

CKD testing rates among DM adults in the MHS were higher than other national-level data. However, there is a substantial opportunity to improve early detection of CKD in this high-risk population.

The views expressed in this abstract are those of the authors and do not necessarily reflect the official policy of the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., the Department of Defense, the Department of Health and Human Services, or the U.S. government.

Funding

• Other U.S. Government Support