A New Study Highlights Undiagnosed Kidney Disease in Medicare Beneficiaries

November 3, 2020 · Jazmyne Carter

Chronic kidney disease (CKD) is one of those diseases that adds to a long list of health risks to vulnerable populations.

Thirty-seven million adults in the United States have CKD. That’s alarming.

But do you know what’s even more alarming? 90% don’t know they have it.

CKD is a gradual loss of kidney function. While many experience minor kidney damage with few symptoms, for some it can progress to kidney failure that requires dialysis. Even if a patient does not get to the point of kidney failure, having CKD can lead to hypertension, heart disease, anemia, dementia, cancer, and death.

Rates of CKD are increasing in Medicare beneficiaries. In 2017, 15% of Medicare recipients over age 65 had CKD. That may seem like a low number, but evidence suggests the actual number may be substantially higher. How many cases of CKD go undiagnosed? Why do cases of CKD go undiagnosed?  What might improve diagnosing of CKD?

A recent analysis examined CKD recognition and severity in Medicare Advantage beneficiaries to help shed some light on undiagnosed cases. Here are a few points from the study:

  • Diagnosing of CKD Needs Improvement. The analysis found that more than 70% of beneficiaries whose lab results indicated CKD did not have a diagnosis code for CKD. Beneficiaries at later stages of CKD were more likely to be clinically recognized, but over half with stage 3 CKD remained undiagnosed. This is not a good thing because patients diagnosed at a late stage of CKD may have limited options for preventing kidney failure.
  • Nephrologist Visits Matter. A visit to a nephrologist improves the chance of having a diagnosis and provides the opportunity to delay the progression of CKD disease and prepare for renal replacement therapy.
  • Black Beneficiaries are More Likely to Have a Diagnosis. This may reflect clinician awareness that racial and ethnic minorities face higher risks of developing kidney disease and kidney failure.
  • Lab Data Help Identify CKD Patients. Combining lab values and diagnostic coding works. Results suggest that using ICD-9 based diagnosis codes to identify patients with CKD just is not enough since it significantly under-identifies patients with CKD.

This study confirms previous findings regarding under-diagnosis of CKD patients. It suggests that by linking data sources we can improve the ability to identify CKD and to study its progression and pinpoint areas for improvements in care.

This study resulted from NCQA’s work with CMS Office of Minority Health to identify and address disparities in care for patients with CKD. Last but certainly not least, kudos to NCQA’s very own Karen Onstad for contributing to this powerful study.


The analyses upon which this publication is based were performed under Contract HHSM-500-2016-00097G, entitled, “Health Equity Innovation Incubator ,”funded by the Centers for Medicare & Medicaid Services, Department of Health and Human Services. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does the mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. The author assumes full responsibility for the accuracy and completeness of the ideas presented.
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