Physicians may underdiagnose CKD in low-risk patient populations
Recently published findings suggested that clinicians overlooked the prevalence of chronic kidney disease in patient populations that were traditionally considered low risk.
The lower-risk populations included women, active-duty military, white individuals and those without diabetes or hypertension.
“Lack of CKD coding in these traditionally low CKD risk groups suggests clinicians may be missing CKD diagnoses — despite available laboratory data indicative of CKD,” Jenna M. Norton, MPH, of the department of preventive medicine and biostatistics at the Uniformed Services University of Health Sciences in Maryland, and colleagues wrote. “As a result, these individuals with uncoded CKD may not be receiving appropriate management to slow progression of the disease and address potential complications.”
Norton and colleagues investigated laboratory and diagnosis code data to determine trends in how CKD is recorded with diagnosis codes in this cross-sectional study. They evaluated the prevalence of CKD coding among 3,330,893 patients aged 18 to 64 years who were beneficiaries of the Military Health System between 2016 and 2018. Researchers defined coded CKD by the presence of an ICD-10 code and uncoded CKD by a positive e-phenotype result without the ICD-10 labeling. Norton and colleagues compared the patient populations who had CKD coded and uncoded using two-tailed t-tests and the Pearson’s Chi Square test.
The comparison revealed an overall CKD prevalence of 3.2%. However, 63% of those identified as having CKD were uncoded. Patients with uncoded CKD were more often younger (mean age 45 vs. 52 years), women (54.4% vs. 37.6%) and active duty (20.2% vs. 12.5%), and less often of Black race (18.5% vs. 31.5%) or with diabetes (23.5% vs. 43.5%) or hypertension (46.6% vs. 77.1%) compared with beneficiaries with coded CKD, according to the researchers. Lack of coding was also more common among patients in the early stages of CKD.
“Application of the [National Institute of Diabetes and Digestive and Kidney Diseases] NIDDK CKD e-phenotype in population health management initiatives in the clinical setting could potentially help identify these individuals likely to have CKD, thereby enabling improved disease management,” Norton and colleagues wrote.
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