Clinicians may be missing chronic kidney disease (CKD) in groups considered to be at lower risk for it, potentially resulting in suboptimal care, according to investigators.

In a study of 3,330,893 US Military Health System (MHS) beneficiaries aged 18 to 64 years who received care during 2016-2018 (including active duty personnel, retirees, and their families), the prevalence of CKD was 3.2%, Jenna Norton, PhD, MPH, of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) in Bethesda, Maryland, and colleagues reported in Kidney Medicine. However, 63% of these CKD cases were uncoded.

The investigators used both laboratory and ICD-10 diagnosis codes to identify the total number of people with CKD in the MHS. The NIDDK e-phenotype for CKD, which has 99% sensitivity and specificity, includes 2 consecutive results of an estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73 m2, a urinary albumin to creatinine ratio (UACR) of 30 mg/g or more, a urinary protein to creatinine ratio (UPCR) of 150 mg/g, or a dipstick urine albumin value of 1+ or greater.

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Beneficiaries with coded vs uncoded CKD had significantly more kidney test results. More than half of the total MHS population lacked any kidney test results, however, likely leading to many missed CKD cases.

Patients with established risk factors for CKD, such as diabetes or hypertension, tended to have an ICD-10 code for CKD, the investigators reported. Patients with uncoded CKD were significantly more likely to be in traditionally lower risk groups, including younger (age 45 vs 52 years), female (54.4% vs 37.6%), and active duty (20.2% vs 12.5%), and significantly less likely to have Black race (18.5% vs 31.5%), diabetes (23.5% vs 43.5%), hypertension (46.6% vs 77.1%), and obesity (45.8% vs 54.1%).

“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,” Dr Norton’s team stated. “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 JM, Grunwald L, Banaag A, et al. CKD prevalence in the military health system: coded versus uncoded CKD. Kidney Med. Published online June 2, 2021. doi:10.1016/j.xkme.2021.03.015