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<h1>2012 National Healthcare Quality and Disparities Reports</h1>
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<h3>Effectiveness of Care: Chronic Kidney Disease</h3>
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<p><a id="esrd" name="esrd"></a><a href="#manag1"><strong>Management of End Stage Renal Disease</strong></a><br /><a href="#managmt1">Dialysis patients under age 70 who were registered on a waiting list for transplantation</a><br /><a href="#managmt2">Patients with treated chronic kidney failure who received a transplant within 3 years of date of renal failure</a><br /><a href="#managmt3">Ratio of observed deaths to expected deaths among Medicare hemodialysis patients</a><br /><br /><strong><a href="#chronic">Chronic Care of End Stage Renal Disease</a></strong><br /><a href="#chronc1">Adult hemodialysis patients whose primary mode of vascular access is an arteriovenous fistula (AVF)</a><br /><a href="#chronc2">End stage renal disease (ESRD) patients who visited a nephrologist before renal replacement therapy</a></p><hr /><p><a id="manag1" name="manag1"></a><a id="managmt1" name="managmt1"> </a></p><h2>Management of End Stage Renal Disease</h2><h3>Measure Title</h3><p>Dialysis patients under age 70 who were registered on a waiting list for transplantation.</p><h3>Measure Source</h3><p>Healthy People 2020.</p><h3>National Table</h3><p>2_3_1_4.1 Dialysis patients under age 70 who were registered on a waiting list for transplantation, United States, 2000-2008</p><h3>National Data Source</h3><p>National Institutes of Health (NIH), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), United States Renal Data System (USRDS).</p><h3>National Denominator</h3><p>All incident end stage renal disease (ESRD) patients with Medicare who are under the age of 70 and known to reside in the 50 States or DC. Patients who received a transplant at any time from a live donor were excluded from the measure.</p><h3>National Numerator</h3><p>Subset of the denominator who were registered on the kidney transplant waiting list on December 31 of the measure year or received a deceased-donor kidney within 1 year of their ESRD initiation date.</p><h3>State Table</h3><p>2_3_1_4.3 Dialysis patients under age 70 who were registered on a waiting list for transplantation, by State, United States, 2000-2008</p><h3>State Data Source</h3><p>NIH, NIDDK, USRDS.</p><h3>State Denominator</h3><p>Same as national.</p><h3>State Numerator</h3><p>Same as national.</p><h3>Comments</h3><p>The measure was calculated as the percentage (by Kaplan-Meier methodology) who were either wait-listed or received a deceased-donor kidney within 1 year of their ESRD initiation date.</p><p>This measure is referred to as measure CKD-12 in Healthy People 2020 documentation.</p><p class="size2"><a href="#esrd">Top of Page</a></p><hr /><p><a id="managmt2" name="managmt2"> </a></p><h2>Management of End Stage Renal Disease</h2><h3>Measure Title</h3><p>Patients with treated chronic kidney failure who received a transplant within 3 years of date of renal failure.</p><h3>Measure Source</h3><p>Healthy People 2020.</p><h3>National Table</h3><p>2_3_1_5.1 Patients with treated chronic kidney failure who received a transplant within 3 years of date of renal failure, United States, 2000-2006</p><h3>National Data Source</h3><p>National Institutes of Health (NIH), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), United States Renal Data System (USRDS).</p><h3>National Denominator</h3><p>All Medicare dialysis patients who initiated therapy in the given year. Patients with prior kidney transplants and those over the age of 69 were excluded.</p><h3>National Numerator</h3><p>Subset of the denominator receiving a transplant within 3 years of renal failure.</p><h3>State Table</h3><p>2_3_1_5.3 Patients with treated chronic kidney failure who received a transplant within 3 years of date of renal failure, by State, United States, 2000-2006</p><h3>State Data Source</h3><p>NIH, NIDDK, USRDS.</p><h3>State Denominator</h3><p>Same as national.</p><h3>State Numerator</h3><p>Same as national.</p><h3>Comments</h3><p>This measure is referred to as measure CKD-13.1 in Healthy People 2020 documentation.</p><p class="size2"><a href="#esrd">Top of Page</a></p><hr /><p><a id="managmt3" name="managmt3"> </a></p><h2>Management of End Stage Renal Disease</h2><h3>Measure Title</h3><p>Ratio of observed deaths to expected deaths among Medicare hemodialysis patients.</p><h3>Measure Source</h3><p>University of Michigan Kidney Epidemiology and Cost Center (UM-KECC), Unit Specific Report (USR).</p><h3>State Table</h3><p>2_3_1_3.1 Standardized mortality ratio for dialysis patients, by State, United States, 2000-2010.</p><h3>State Data Source</h3><p>UM-KECC, USR.</p><h3>State Denominator</h3><p>Medicare dialysis patients.</p><h3>State Numerator</h3><p>Standardized mortality among the denominator population.</p><h3>Comments</h3><p>Standardized mortality ratios (SMRs) are used to compare mortality in annual incident populations over successive years of observation. The death rates are high during the first year of treatment, lower during the second and third years, and rise again after the fourth year.</p><p>The Medicare Compare measure pertaining to Dialysis Facility, "patient survival rate," is equivalent to the University of Michigan SMR.</p><p class="size2"><a href="#esrd">Top of Page</a></p><hr /><p><a id="chronic" name="chronic"></a><a id="chronc1" name="chronc1"> </a></p><h2>Chronic Care of End Stage Renal Disease</h2><h3>Measure Title</h3><p>Adult hemodialysis patients whose primary mode of vascular access is an arteriovenous fistula (AVF).</p><h3>Measure Source</h3><p>Centers for Medicare & Medicaid Services (CMS), End Stage Renal Disease (ESRD), Standard Information Management System (SIMS)</p><h3>National Table</h3><p>2_3_1_2.1 New end stage renal disease patients who initiated hemodialysis with an arteriovenous fistula, United States, 2008-2011</p><h3>National Data Source</h3><p>CMS Fistula First Incident AVF Dataset.</p><h3>National Denominator</h3><p>All patients in 18 ESRD networks who began outpatient dialysis in the designated year.</p><h3>National Numerator</h3><p>Subset of the denominator who initiated dialysis with an AVF.</p><h3>State Tables</h3><p>2_3_1_2.2 New end stage renal disease patients who initiated hemodialysis with an arteriovenous fistula, by State, United States, 2008-2011</p><p>2_3_1_2.3a-d New end stage renal disease patients who initiated hemodialysis with an arteriovenous fistula, United States, 2008-2011, by:</p><ol type="a"><li>State and race</li><li>State and ethnicity</li><li>State and age</li><li>State and gender</li></ol><h3>State Data Source</h3><p>Same as national.</p><h3>State Denominator</h3><p>All new ESRD patients in 18 ESRD networks who began chronic outpatient dialysis in the designated year.</p><h3>State Numerator</h3><p>Same as national.</p><h3>Comments</h3><p>Data for 2009 and 2010 were drawn from the SIMS Central Repository on May 17, 2011.</p><p class="size2"><a href="#esrd">Top of Page</a></p><hr /><p><a id="chronc2" name="chronc2"> </a></p><h2>Chronic Care of End Stage Renal Disease</h2><h3>Measure Title</h3><p>End stage renal disease (ESRD) patients who visited a nephrologist before renal replacement therapy.</p><h3>Measure Source</h3><p>National Institutes of Health (NIH), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), U.S. Renal Data System (USRDS).</p><h3>National Tables</h3><p>2_3_1_1.2_1 End stage renal disease patients age 18 and over who saw a nephrologist at least 12 months prior to initiation of renal replacement therapy, United States, 2006-2008</p><p>2_3_1_1.1_2a-b End stage renal disease patients age 18 and over who saw a nephrologist at least 12 months prior to initiation of renal replacement therapy, United States, 2009, by:</p><ol type="a"><li>Race.</li><li>Ethnicity.</li></ol><h3>National Data Source</h3><p>NIH, NIDDK, USRDS.</p><h3>National Denominator</h3><p>All incident ESRD patients age 18 and over.</p><h3>National Numerator</h3><p>Subset of the denominator who saw a nephrologist at least 12 months prior to initiation of renal replacement therapy.</p><p class="size2"><a href="#esrd">Top of Page</a></p><p class="size2"><a href="/research/findings/nhqrdr/nhqrdr12/measurespec/index.html">Return to Contents</a><br /><a href="/research/findings/nhqrdr/nhqrdr12/measurespec/diabetes.html">Proceed to Next Section</a></p></div>
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<div class="current-as-of">Page last reviewed June 2013</div>
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<div class="citation">
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<span>Internet Citation: 2012 National Healthcare Quality and Disparities Reports: Effectiveness of Care: Chronic Kidney Disease.
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June 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://archive.ahrq.gov/research/findings/nhqrdr/nhqrdr12/measurespec/kidney.html</span>
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