finding what you need

in the annual data report

tables of contents listing all chapters
in the ckd and esrd volumes, the main
topics covered within them, and the
reference sections and appendices;
pages 811 and 130132.
chapter tables of contents listings of
all two-page spreads; found on the
second page of each chapter.
guide to topics listings of central
topics in the adr; pages 1213.
data appearing each year in the adr
list of tables and figures; ckd:
page 14; esrd: pages 134135
cd-rom both volumes of the adr,
slides of all figures, excel files of
all data, and complete reference
tables; inside the back cover.
chapter summaries central points
from each two-page spread; found
on the last page of each chapter.
analytical methods describing the
methods used for each figure and table;
ckd: pages 119127; esrd: pages 371399.
reference tables ckd: pages 101117;
esrd: pages 303369.
glossary with a list of acronyms;
page 406.
united states renal data system
2011 USRDS ANNUAL
DATA REPORT
volume one
atlas of chronic kidney
disease in the united states
NATIONAL INSTITUTES OF HEALTH
NATIONAL INSTITUTE OF DIABETES & DIGESTIVE & KIDNEY DISEASES
DIVISION OF KIDNEY, UROLOGIC, & HEMATOLOGIC DISEASES
page
6
FUNDING & CHAPTER CONTRIBUTORS
Production of this Annual Data Report (adr) was solely funded through nih contract hhsn
267 2007 15002c / no1-dk-7-5002 with the Minneapolis Medical Research Foundation (mmrf). Most
contributors to this report are employed by mmrf, with many of the physician investigators
being employed by mmrfs parent organization, Hennepin Faculty Associates. mmrf has
enacted confict of interest (coi) policies and practices governing the conduct of research
within the usrds and of other research not related to the usrds. In addition to internal controls,
usrds work is overseen by niddk Project Officers, the usrds Steering Committee, and the
usrds External Advisory Committee. Listed here are those who contributed to the 2011 adr.
Unless otherwise noted in parentheses, the contributors employer was mmrf or its parent
organization, Hennepin Faculty Associates. DIRECTORS & CO-INVESTIGATORS Allan Collins, md,
facp, usrds Director (entire adr). Robert Foley, mb, msc, usrds Deputy Director (entire adr).
Blanche Chavers, md (University of Minnesota School of Medicine; Vol 2, Ch 8). David Gilbertson,
phd (entire adr). Charles Herzog, md (Vol 1, Ch 4; Vol 2, Ch 4). Kirsten Johansen, md (University
of California at San Francisco; Vol 2, Ch 9). Bertram Kasiske, md (Vol 2, Ch 7). Nancy Kutner, phd
(Emory University; Vol 2, Ch 9). Suying Li, phd (Vol 1, Ch 3; Vol 2, Prcis & Chs 5, 8; H & I tables).
Jiannong Liu, phd (maps; Vol 2, Ch 10; E tables). Wendy St. Peter, PharmD, bcps (Vol 1, Chs 2, 5,
& 6; Vol 2, HP2010, Chs 2, 6, & 11). Jon Snyder, phd (Vol 2, Ch 7). Craig Solid, phd (entire adr).
STAFF administrative staff Beth Forrest, bba (Vol 2, HP2010, Ch 12). adr production Edward
Constantini, ma (entire adr). Susan Everson, phd (entire adr). biostatisticians Haifeng Guo, ms
(Vol 1, Ch 2; Vol 2, HP2010, Chs 2, 8, 10). Sally Gustafson, MS (Vol 2, F tables). Brooke Heubner,
MS (Vol 2, Ch 7). Kenneth Lamb, phd (Vol 2, Ch 7). Shuling Li, ms (Vol 1 , Ch 4; Vol 2, HP2010 &
Ch 4). Yi Peng, MS (Vol 1, Ch 1). Yang Qiu, ms (Vol 2, Ch 7). Tricia
Roberts, ms (Vol 1, Ch 3; Vol 2, Prcis & Chs 3, 8; G tables). Melissa
Skeans, ms (Vol 2, Prcis, HP2010, Chs 1 & 7; E & F tables). Bryn
Thompson, BA (Vol 2, Ch 7; E tables). Changchun Wang, ms
(Vol 1, Chs 1 & 2; Vol 2, HP2010). Eric Weinhandl, ms (Vol 1, Chs 4
& 5; Vol 2, Chs 2, 4, 6). David Zaun, ms (Vol 2, Ch 2). information
systems and software development for all chapters, with
additional work as noted: Cheryl Arko, ba. Shu-Cheng Chen,
ms (Vol 2, Prcis & Ch 1; D tables). Frank Daniels, bs. James Ebben,
bs (Vol 1, Chs 5 & 6; Vol 2, Prcis & Chs 6, 10, & 11; K tables). Eric
Frazier, bs (Vol 2, Prcis, HP2010, Chs 1, 2, & 8; A, B, C, M tables).
Christopher Hanzlik, bs. Roger Johnson. C Daniel Sheets, bs.
Xinyue Wang, ba/bs.
Allan Collins, md, facp Consultant/honoraria: Amgen, Merck, NxStage, Takeda. Equity
ownership: Physician Nexus. Robert Foley, mb, msc Consultant/honoraria: 21st Services,
Luitpold, Novartis. David Gilbertson, phd Consultant/honoraria: Affymax, Amgen, DaVita
Clinical Research. Charles Herzog, md Consultant/honoraria: Abbott, Amgen, Affymax,
Cor-Medix, Fibrogen, Fresenius Health Partners, Merck, UpToDate. Equity ownership: Boston
Scientific, Cambridge Heart, Johnson & Johnson, Merck. Trustee: RoFAR. Kirsten Johansen,
md Consultant/honoraria: Amgen. Research support (non-salary): Abbott, Amgen. Bertram
Kasiske, md Consultant/honoraria: Litholink. Suying Li, phd Consultant/honoraria: National
Kidney Foundation. Wendy St. Peter, PharmD Consultant/honoraria: Mitsubishi Tanabe Pharma.
Also, mmrf as an institution has separate contracts to conduct other, independent research
funded by the Agency for Healthcare Research and Quality (via subcontract with Johns
Hopkins University), Amgen, Bristol-Myers Squibb, DaVita, Fresenius, the Centers for Disease
Control and Prevention, Genzyme, Mitsubishi Tanabe Pharma America, the National Institute
on Aging/National Institutes of Health, the National Kidney Foundation, NxStage, Ortho-
McNeil-Janssen, Shire, and Takeda.
This twenty-third annual report of the United States Renal Data System is produced by the
usrds Coordinating Center, operated under nih contract hhsn 267 2007 15002c / no1-dk-7-5002
by the Minneapolis Medical Research Foundation. SUGGESTED CITATION FOR THIS REPORT u.s.
Renal Data System, usrds 2011 Annual Data Report: Atlas of Chronic Kidney Disease and End-
Stage Renal Disease in the United States, National Institutes of Health, National Institute of
Diabetes and Digestive and Kidney Diseases, Bethesda, md, 2011. PUBLICATIONS BASED UPON DATA
REPORTED HERE OR SUPPLIED UPON REQUEST MUST INCLUDE THIS CITATION AND THE FOLLOWING
NOTICE The data reported here have been supplied by the United States Renal Data System
(usrds). The interpretation and reporting of these data are the responsibility of the author(s)
and in no way should be seen as an ofcial policy or interpretation of the u.s. government.
FIGURE REFERENCES In titles, the superscript number or letter refers to the chapter, the following
number or letter identifes the fgure or table, and the roman numeral identifes the volume.
Citations should separate chapter, number, and volume by periods i.e., 3.1.ii refers to Chapter
Three, Figure 1, Volume Two.
DISCLOSURES FOR POTENTIAL
CONFLICTS OF INTEREST
And Ill tell it and think it and speak it and breathe it
And refect it from the mountain so all souls can see it
Then Ill stand on the ocean until I start sinkin
But Ill know my song well before I start singin
And its a hard, its a hard, its a hard, its a hard
Its a hard rains a-gonna fall
Bob Dylan, A Hard Rains a-Gonna Fall
page
7
CONTENTS
prcis an introduction
to esrd in the u.s. 147
healthy people 2020 167
1 incidence, prevalence,
patient characteristics,
and modalities 183
2 clinical indicators and
preventive care 195
3 hospitalization 205
4 cardiovascular disease 217
5 mortality 225
6 prescription drug
coverage in esrd
patients 233
7 transplantation 247
8 pediatric esrd 257
9 special studies 267
10 esrd providers 271
11 costs of esrd 281
12 international
comparisons 291
reference tables: esrd 303
analytical methods: esrd 371
usrds products and
services 400
glossary 406
cms forms 411
colophon 418
data requests 400
data release agreement 409
chapter details 10
guide to topics in the adr 12
list of ckd figures and tables
appearing each year 14
volume one highlights 16
overview of ckd in the u.s. 18
introduction 22
prcis an introduction
to ckd in the u.s. 27
1 ckd in the general
population 37
2 identification and care
of patients with ckd 45
3 morbidity and mortality
in patients with ckd 59
4 cardiovascular disease
in patients with ckd 69
5 prescription drug
coverage in ckd patients 77
6 costs of ckd 91
reference tables: ckd 101
analytical methods: ckd 119
page
8
volume one
CKD
volume two
ESRD
page
9
prcis an introduction to ckd in the u.s. 27
1 ckd in the general population 37
strategies for identifying ckd; comorbidity; awareness,
treatment, and control of disease conditions; mortality
2 identification and care of patients with ckd 45
prevalence of recognized ckd; laboratory testing of
patients at risk for ckd; probability and odds of a ckd
diagnosis code; probability and odds of seeing a physician
post-ckd diagnosis; prescription drug therapy
3 morbidity and mortality in patients with ckd 59
hospitalization rates in ckd and non-ckd patients;
hospitalizations due to infection; mortality rates
4 cardiovascular disease in patients with ckd 69
rates of cardiovascular disease; prescription drug therapy
5 prescription drug coverage in ckd patients 77
medicare part d enrollment patterns in patients with ckd;
medicare part d coverage plans; overall costs of part d
enrollment; coverage phase analyses for part d enrollees;
medicare part d prescription drug use and costs
6 costs of ckd 91
overall costs of ckd; components of costs
for ckd; medicare part d costs
reference tables: ckd 101
volume two esrd
prcis an introduction to esrd in the u.s. 147
healthy people 2020 167 recommended care among patients
with aki, diabetes, and ckd; acei/arb treatment; esrd
incidence; kidney failure due to diabetes; nephrologist
care; vascular access; transplantation; mortality
1 incidence, prevalence, patient characteristics, and
treatment modalities 183 incident and prevalent counts
and rates; incident and prevalent modality; patient care
prior to initiation; anemia; laboratory values
2 clinical indicators and preventive care 195 anemia treatment;
preventive care; vascular access; medicare part d use
3 hospitalization 205 overall hospitalization; rehospitalization;
infectious hospitalization by major organ system;
hospitalization in matched dialysis populations
4 cardiovascular disease 217 mortality; prescription drug therapy
5 mortality 225 mortality; survival; mortality
in the general and esrd populations
6 prescription drug coverage in esrd patients 233 medicare
part d enrollment patterns; medicare part d coverage plans; overall
costs of part d enrollment; coverage phase analyses for part d
enrollees; medicare part d prescription drug use and costs
c
h
a
p
t
e
r
d
e
t
a
il
s
page
10
volume one
CKD
2 clinical indicators and preventive care 195 anemia treatment;
preventive care; vascular access; medicare part d use
3 hospitalization 205 overall hospitalization; rehospitalization;
infectious hospitalization by major organ system;
hospitalization in matched dialysis populations
4 cardiovascular disease 217 mortality; prescription drug therapy
5 mortality 225 mortality; survival; mortality
in the general and esrd populations
6 prescription drug coverage in esrd patients 233 medicare
part d enrollment patterns; medicare part d coverage plans; overall
costs of part d enrollment; coverage phase analyses for part d
enrollees; medicare part d prescription drug use and costs
7 transplantation 247 wait list; donation; transplant; outcomes; follow-up care
8 pediatric esrd 257 esrd diagnosis in the pediatric population;
infections; vaccinations; hospitalization; mortality
9 nutrition, rehabilitation/quality of life, and cardiovascular special studies 267
active/adipose: a cohort study to investigate the value of exercise in esrd/
analyses designed to investigate the paradox of obesity and survival in esrd
10 esrd providers 271 provider growth; anemia treatment; preventive care;
costs for intervention; standardized hospitalization and mortality ratios
11 costs of esrd 281 overall costs of esrd and injectables; racial diferences;
matched and unmatched dialysis populations; medicare part d costs
12 international comparisons 291 worldwide view of the incidence of
esrd; incidence of esrd; prevalence of esrd; dialysis; transplantation
reference tables: esrd 303
page
11
GUIDE TO TOPICS
IN THE ANNUAL DATA REPORT
populations
nhanes CKD (VOL 1): CHAPTER 1
new patients ESRD (VOL 2): P.A, HP-8,
HP-9, 1.1, 1.38, 1.D15, 8.1A
existing patients CKD (VOL 1): 1.A2, 2.15;
ESRD (VOL 2): P.A, 1.1, 1.914, 1.E16, 8.2
transplant patients ESRD (VOL 2): CHAPTER 7
ckd datasets (VOL 1) 2.A2
pediatric patients ESRD (VOL 2): CHAPTER 8
international comparisons ESRD (VOL 2): CHAPTER 12
medicare part d coverage CKD (VOL 1): CHAPTER 5, 6.B22;
ESRD (VOL 2): CHAPTER 6, 11.A36
diseases
identifying ckd (VOL 1): 1.A7, 2.D9
comorbidity CKD (VOL 1): 1.1, 1.45, 1.7, 2.1
anemia ESRD (VOL 2): 1.20G, 2.24
infections CKD (VOL 1): 3.8B; ESRD (VOL 2):
3.1, 3.3D, 5.3, 5.5, 8.24, 8.9, 8.12
cardiovascular disease CKD (VOL 1): 3.2,
3.5, 3.11, CHAPTER 4; ESRD (VOL 2):
CHAPTER 4, 5.3, 5.67, 8.8, 8.11
diabetes CKD (VOL 1): 1.1B; ESRD (VOL 2): HP-9
treatment
preventive care and laboratory testing CKD (VOL 1): 2.6C;
ESRD (VOL 2): 1.2023, 2.8A, 7.32, 8.56, 10.1015
awareness/treatment/control CKD (VOL 1): 1.B
physician care/follow-up care CKD (VOL 1): 2.1013;
ESRD (VOL 2): HP-3, HP-4, HP-5, HP-10, 1.F19
drug therapy CKD (VOL 1): 2.1421, 4.B4.11, 5.E21;
ESRD (VOL 2): HP-5, 2.1521, 4.B10, 7.2731
anemia treatment ESRD (VOL 2): 2.3, 2.57, 10.59
dialysis access ESRD (VOL 2): HP-11, 2.12C
transplantation (vol 2) HP-12, HP-13, CHAPTER 7
outcomes
hospitalization CKD (VOL 1): 3.17; ESRD (VOL 2):
CHAPTER 3, 7.2122, 8.24, 8.79, 10.1825
rehospitalization ESRD (VOL 2): 3.4B
mortality CKD (VOL 1): 1.812, 3.912; ESRD (VOL 2): HP-14,
4.14, CHAPTER 5, 7.26, 8.1012, 10.1825
survival ESRD (VOL 2): 5.A, 7.1718, 8.13
costs
part d CKD (VOL 1): 5.1114, 6.922; ESRD (VOL 2): 6.1419, 6.CD
overall CKD (VOL 1): CHAPTER 6; ESRD (VOL 2): 10.1617, CHAPTER 11
data analysis
analytical methods CKD (VOL 1): PG 119; ESRD (VOL 2): PG 371
data files available to researchers PG 400
agreement for release of data PG 409
page
12
page
13
CKD DATA
APPEARING EACH YEAR IN THE ADR
chapter one
1.5 Prevalence of comorbidity in NHANES participants, by risk factor,
expanded eGFR categories, & method used to estimate GFR
1.a Prevalence & odds ratios of CKD in NHANES participants, by method
used to estimate GFR, age, gender, race/ethnicity, & risk factor
1.b Awareness, treatment, & control of hypertension, hypercholesterolemia,
HDL cholesterol, & diabetes, by ACR, eGFR, & method used to estimate GFR
chapter two
2.3 Trends in CKD prevalence: Medicare patients age 65 & older, by race
2.6 Probability of microalbumin & creatinine testing
in Medicare patients at risk for CKD
2.10 Cumulative probability of a physician visit at month 12 following
CKD diagnosis, by physician specialty & dataset
2.14 Medicare Part D & MarketScan CKD patients with at least one
claim for an ACEI/ARB/renin inhibitor, by CKD diagnosis code
2.15 Medicare Part D & MarketScan CKD patients with at least
one claim for a beta blocker, by CKD diagnosis code
2.a Descriptive parameters of CKD datasets, by age,
gender, race, ethnicity, & coded comorbidity
2.b Prevalence of recognized CKD,
by dataset, year, & age
2.c Probability of laboratory testing in patients at
risk for CKD, by demographic characteristics
2.d Percent of patients with a CKD diagnosis
code, by demographic characteristics,
comorbidity, & dataset
2.g Cumulative probability of a physician
visit at month 12 after CKD diagnosis
2.h Cumulative probability of a physician visit at month
12 after a CKD diagnosis code of 585.3 or higher
chapter three
3.1 All-cause hospitalization rates in the Medicare
& MarketScan populations, by CKD status
3.a Adjusted hospitalization rates in Medicare
patients, by CKD diagnosis code
3.5 Adjusted rates of hospitalization for cardiovascular
disease, by dataset & CKD diagnosis code
3.6 Adjusted rates of hospitalization for infection,
by dataset & CKD diagnosis code
3.b Rates of hospitalization due to
infection, by organ system
3.c Adjusted mortality rates in Medicare
patients, by CKD diagnosis code
3.9 All-cause mortality rates in Medicare
CKD & non-CKD patients
chapter four
4 .1 Cardiovascular disease in patients with or without CKD
4.7 Prescription drug therapy in patients with CHF, by CKD status & race
4.a Cardiovascular disease & intervention,
by CKD status & diagnosis code
4.b CVD & pharmacological intervention, by CKD status & diagnosis code
chapter five
5.1 Sources of prescription drug coverage in Medicare enrollees
5.23 Sources of prescription drug coverage in Medicare
& CKD Part D enrollees, by age & race
5.5 Medicare Part D enrollees, by low income subsidy status
5.7 Medicare Part D beneft parameters
5.13 PPPY part D costs for Medicare enrollees,
by low income subsidy status
5.a Medicare Part D enrollees with low income subsidy, by CKD stage
5.b Total per person per year costs for Medicare Part D
enrollees, by CKD stage & LIS subsidy status
5.c Twelve-month probability of reaching the coverage
gap in Part D non-LIS enrollees, by CKD stage
5.eg Top 15 drugs used in general Medicare Part D
enrollees overall and with CKD, by frequency & net cost
chapter six
6.1 Point prevalent distribution & annual costs of
(fee-for-service) Medicare patients, age 65
& older, with diagnosed diabetes, CHF, & CKD
6.5 Overall expenditures for CKD in the Medicare population
6.a PPPY inpatient/outpatient & physician/supplier
net costs for CKD, by CKD diagnosis code
6.b Top 25 drugs used in general Medicare Part D
enrollees with CKD, by frequency & net cost

page
14
page
15
page
16
patients
7.8%
prevalence of egfr <60 in nhanes
20012008 participants: mdrd
formula TABLE 1.A
AMONG THOSE WITH SELF-REPORTED DIABETES
21.3% AMONG THOSE WITH SELF-REPORTED
CARDIOVASCULAR DISEASE 30.1%
6.9%
prevalence of egfr <60 in nhanes
20012008 participants: ckd-epi
formula TABLE 1.A
AMONG THOSE WITH SELF-REPORTED DIABETES
19.8% AMONG THOSE WITH SELF-REPORTED
CARDIOVASCULAR DISEASE 29.8%
9.9%
prevalence of acr 30 in nhanes
20012008 participants TABLE 1.A
AMONG THOSE WITH SELF-REPORTED DIABETES
33.4% AMONG THOSE WITH SELF-REPORTED
CARDIOVASCULAR DISEASE 24.8%

8.5%
prevalence of recognized ckd in
medicare patients age 65 and older,
2009 TABLE 2.B
WHITE 8.1% AFRICAN AMERICAN 12.8%
patient care
85%
hypertension among patients
with egfr <60 CKD-EPI FORMULA; TABLE 1.B
23%
patients with egfr <60 whose
hypertension is treated
and controlled CKD-EPI FORMULA; TABLE 1.B
66%
hypercholesterolemia among patients
with egfr <60 CKD-EPI FORMULA; TABLE 1.B
24%
patients with egfr <60 whose
hypercholesterolemia is treated
and controlled CKD-EPI FORMULA; TABLE 1.B
42%
patients with diabetes and egfr <60 whose
diabetes is uncontrolled CKD-EPI FORMULA; TABLE 1.B

0.62
cumulative probability of a nephrologist
visit at month 12 after a ckd diagnosis of
585.3 or higher, 2009: medicare patients
age 65+ TABLE 2.H

0.51
cumulative probability of a nephrologist
visit at month 12 after a ckd diagnosis of
585.3 or higher, 2009: marketscan patients
age 5064 TABLE 2.H

55%
ckd patients receiving an
acei or arb, 2008 FIGURE 4.11

65%
ckd patients receiving a
beta blocker, 2008 FIGURE 4.11
volume one
HIGHLIGHTS
page
17
expenditures

$3.5
billion
total net part d payment for medicare
enrollees with ckd, 2008 FIGURE 5.11

$3,547
per person per year medicare part d
costs for enrollees with ckd, 2008 FIGURE 5.12

$708
per person per year out-of-pocket part d
costs for enrollees with ckd, 2008 FIGURE 5.12

$34
billion
total medicare expenditures
for ckd, 2009 FIGURE 6.5 (EXCLUDES PART D)

$18
billion
medicare expenditures for patients
with ckd and diabetes, 2009
FIGURE 6.6 (EXCLUDES PART D)

$16
billion
medicare expenditures for patients with
ckd and congestive heart failure, 2009
FIGURE 6.7 (EXCLUDES PART D)

$20,432
per person per year expenditures for ckd
in the general medicare population, 2009
FIGURE 6.8 (EXCLUDES PART D)
NON-DM/NON-CHF $14,449 CKD + DM + CHF $34,121
outcomes

446
adjusted hospitalization rates in white
medicare ckd patients age 66 and older, 2009
ADMISSIONS PER 1,000 PATIENT YEARS; FIGURE 3.3
STAGE 12 411 STAGE 3 441 STAGE 45 554

466
adjusted hospitalization rates in african american
medicare ckd patients age 66 and older, 2009
ADMISSIONS PER 1,000 PATIENT YEARS; FIGURE 3.3
STAGE 12 437 STAGE 3 426 STAGE 45 652

75
adjusted mortality rates in white
medicare ckd patients age 66 and older, 2009
DEATHS PER 1,000 PATIENT YEARS; FIGURE 3.12
STAGE 12 64 STAGE 3 61 STAGE 45 103

83
adjusted mortality rates in african american
medicare ckd patients age 66 and older, 2009
DEATHS PER 1,000 PATIENT YEARS; FIGURE 3.12
STAGE 12 71 STAGE 3 62 STAGE 45 113
1999-2004 2004-2008
0
20
40
60
80
100
HTN
controlled controlled
HTN
1999-2004 2004-2008
0
20
40
60
80
100
HTN
controlled controlled
HTN
1999-2004 2004-2008
0
20
40
60
80
100
HTN
controlled controlled
HTN
.++. 1+-, 1--- .
|- .|. :|-|:
February zccz: the National Kidney Foundation
introduces a fve-stage classifcation system for chronic
kidney disease based on an estimated glomerular fltration
rate (eCFR), calculated from serum creatinine levels and
levels of proteinuria, and using data from the National
Health and Nutrition Examination Survey (NHANS).
New ICD--CM stage-specic codes for CkD were
introduced in the fall of 200, providing opportunities to
use dierent datasets like those from employer group
health plans (EGHPs) to track younger populations with
reported diagnosis codes over time.
The Modifcation of Diet in Renal Disease
(MDRD) Study equation and the new
Chronic Kidney Disease Epidemiology
Collaboration (CkD-PI) equation are two
methods used to estimate CFR.
Awareness and control of hypertension (HTN) in NHANES participants with
eGFR <0 ml/min/1. m
2
or ACR 0 mg/g, 2002008 (percent)

||.botos, ccrgost|vo |o..t |.||J.o ,||), .rJ || ..o t|.oo
|rto..o|.toJ c|.cr|c J|so.sos c| c|o.. pJb||c .o|ov.rco
DM 7.2%
CKD 14.7%
CHF 2.4%
DM 8.1%
CKD 14.5%
CHF 2.4%
NHANES 20012004 NHANES 20052008
of patients age
60 and older,
26%
HAVE A GFR <60: MDRD
26%
HAVE A GFR <60: CKD-EPI
20%
HAVE AN ACR 30
of patients
with diabetes,
21%
20%
33%
of patients with
hypertension,
17%
16%
17%
of patients
with CVD,
30%
30%
25%
eGFR <60 (MDRD) eGFR <60 (CKD-EPI) ACR 30
EGHP patients are
much younger than
Medicare patients.
MEAN AGE
77.8
MEDICARE
52.4
MARKETSCAN
51.2
INGENIX I3
CKD is recognized more frequently in Medicare
patients age 65 and older than in the Ingenix i3
and MarketScan populations, age 2064.
RECOGNIZED CKD
Medicare Ingenix i3 MarketScan
2044 0.4% 0.3%
4554 0.9% 0.7%
5564 2.0% 1.7%
6574 6.1%
7584 10.3%
85+ 13.1%
Circle diagram: Figure 1.1
Disease burden: Table 1.a
Awareness/treatment: Table 1.b
Recognized CKD: Tables 2.ab
CKD STAGE MARKERS
oC|| ,o n|/n|r/,, n
.
, .|bJn|r/
c.o.t|r|ro ..t|c ,A|) ,o ng/g
. oC|| 6o8,, A| ,o
, oC|| ,o,,
oC|| ,.,
, oC|| <,
ICD-9-CM CODES
5851 |.cr|c k|Jroy J|so.so, St.go 1
5852 |.cr|c k|Jroy J|so.so, St.go 2 ,n||J)
5853 |.cr|c k|Jroy J|so.so, St.go 3 ,ncJo..to)
5854 |.cr|c k|Jroy J|so.so, St.go 4 ,sovo.o)
5855 |.cr|c k|Jroy J|so.so, St.go 5
oC|| <60 n|/n|r/13 n
2
.rJ ||g| J.|r..y .|bJn|r/c.o.t|ro ..t|c ,A|, 30 ng/g)
..o .sscc|.toJ .|t| c|Jo. .go, J|.botos, |ypo.tors|cr, .rJ c..J|cv.scJ|.. J|so.so
CKD-EPI formula
MarketScan: age 2064 Medicare: age 65+ Ingenix i3: age 2064
+y zcc
All codes
All codes
All codes
All codes

codes

codes

codes

codes
RELATIVE 5.3FOLD
INCREASE IN
RECOGNIZED CKD
+y zcc
African American White
Medicare: White
MarketScan
African American
Ingenix i3
RELATIVE 4.4FOLD
INCREASE IN
RECOGNIZED CKD
+y zcc
RELATIVE 2.4FOLD
INCREASE IN
RECOGNIZED CKD
+y zcc
RELATIVE 2.2FOLD
INCREASE IN
RECOGNIZED CKD

The prevalence of recognized CKD
has increased signifcantly since 1995.
CKD can be
underrecognized
when using only
stage-specifc codes to
estimate its prevalence.
8.+%
c.)%
+z.8%
c.8+%
6.%
c.q+%
+c.y%
c.qz%
microalbumin testing can detect early signs
of
kidney damage
in patients at risk for ckd
PROBABILITY OF TESTING IN 20082009
10%
All patients
33%
Patients with diabetes (no hypertension)
5%
Patients with hypertension (no diabetes)
33%
Patients with both diabetes and hypertension
In patients with diabetes, hypertension, or cardiovascular disease,
the odds of a CKD diagnosis code are

24
times higher
than in patients without these conditions.
Adjusted odds of
a CKD diagnosis Medicare
2.1
3.6
2.5
Diabetes
Hypertension
Cardiovascular disease
MarketScan
3.3
3.3
2.8
Prevalence of CKD: Figures 2.
Recognition of CKD: Figures 2.
Microalbumin testing: Figure 2.
Odd of CKD diagnosis: Table 2.f
8.+% z.% +z.8% c.z% c.6% c.)% c.8+% +.y%
2011
USRDS
ANNUAL
DATA
REPORT
volume
one
ckd
page
18
1999-2004 2004-2008
0
20
40
60
80
100
HTN
controlled controlled
HTN
1999-2004 2004-2008
0
20
40
60
80
100
HTN
controlled controlled
HTN
1999-2004 2004-2008
0
20
40
60
80
100
HTN
controlled controlled
HTN
.++. 1+-, 1--- .
|- .|. :|-|:
February zccz: the National Kidney Foundation
introduces a fve-stage classifcation system for chronic
kidney disease based on an estimated glomerular fltration
rate (eCFR), calculated from serum creatinine levels and
levels of proteinuria, and using data from the National
Health and Nutrition Examination Survey (NHANS).
New ICD--CM stage-specic codes for CkD were
introduced in the fall of 200, providing opportunities to
use dierent datasets like those from employer group
health plans (EGHPs) to track younger populations with
reported diagnosis codes over time.
The Modifcation of Diet in Renal Disease
(MDRD) Study equation and the new
Chronic Kidney Disease Epidemiology
Collaboration (CkD-PI) equation are two
methods used to estimate CFR.
Awareness and control of hypertension (HTN) in NHANES participants with
eGFR <0 ml/min/1. m
2
or ACR 0 mg/g, 2002008 (percent)

||.botos, ccrgost|vo |o..t |.||J.o ,||), .rJ || ..o t|.oo
|rto..o|.toJ c|.cr|c J|so.sos c| c|o.. pJb||c .o|ov.rco
DM 7.2%
CKD 14.7%
CHF 2.4%
DM 8.1%
CKD 14.5%
CHF 2.4%
NHANES 20012004 NHANES 20052008
of patients age
60 and older,
26%
HAVE A GFR <60: MDRD
26%
HAVE A GFR <60: CKD-EPI
20%
HAVE AN ACR 30
of patients
with diabetes,
21%
20%
33%
of patients with
hypertension,
17%
16%
17%
of patients
with CVD,
30%
30%
25%
eGFR <60 (MDRD) eGFR <60 (CKD-EPI) ACR 30
EGHP patients are
much younger than
Medicare patients.
MEAN AGE
77.8
MEDICARE
52.4
MARKETSCAN
51.2
INGENIX I3
CKD is recognized more frequently in Medicare
patients age 65 and older than in the Ingenix i3
and MarketScan populations, age 2064.
RECOGNIZED CKD
Medicare Ingenix i3 MarketScan
2044 0.4% 0.3%
4554 0.9% 0.7%
5564 2.0% 1.7%
6574 6.1%
7584 10.3%
85+ 13.1%
Circle diagram: Figure 1.1
Disease burden: Table 1.a
Awareness/treatment: Table 1.b
Recognized CKD: Tables 2.ab
CKD STAGE MARKERS
oC|| ,o n|/n|r/,, n
.
, .|bJn|r/
c.o.t|r|ro ..t|c ,A|) ,o ng/g
. oC|| 6o8,, A| ,o
, oC|| ,o,,
oC|| ,.,
, oC|| <,
ICD-9-CM CODES
5851 |.cr|c k|Jroy J|so.so, St.go 1
5852 |.cr|c k|Jroy J|so.so, St.go 2 ,n||J)
5853 |.cr|c k|Jroy J|so.so, St.go 3 ,ncJo..to)
5854 |.cr|c k|Jroy J|so.so, St.go 4 ,sovo.o)
5855 |.cr|c k|Jroy J|so.so, St.go 5
oC|| <60 n|/n|r/13 n
2
.rJ ||g| J.|r..y .|bJn|r/c.o.t|ro ..t|c ,A|, 30 ng/g)
..o .sscc|.toJ .|t| c|Jo. .go, J|.botos, |ypo.tors|cr, .rJ c..J|cv.scJ|.. J|so.so
CKD-EPI formula
MarketScan: age 2064 Medicare: age 65+ Ingenix i3: age 2064
+y zcc
All codes
All codes
All codes
All codes

codes

codes

codes

codes
RELATIVE 5.3FOLD
INCREASE IN
RECOGNIZED CKD
+y zcc
African American White
Medicare: White
MarketScan
African American
Ingenix i3
RELATIVE 4.4FOLD
INCREASE IN
RECOGNIZED CKD
+y zcc
RELATIVE 2.4FOLD
INCREASE IN
RECOGNIZED CKD
+y zcc
RELATIVE 2.2FOLD
INCREASE IN
RECOGNIZED CKD

The prevalence of recognized CKD
has increased signifcantly since 1995.
CKD can be
underrecognized
when using only
stage-specifc codes to
estimate its prevalence.
8.+%
c.)%
+z.8%
c.8+%
6.%
c.q+%
+c.y%
c.qz%
microalbumin testing can detect early signs
of
kidney damage
in patients at risk for ckd
PROBABILITY OF TESTING IN 20082009
10%
All patients
33%
Patients with diabetes (no hypertension)
5%
Patients with hypertension (no diabetes)
33%
Patients with both diabetes and hypertension
In patients with diabetes, hypertension, or cardiovascular disease,
the odds of a CKD diagnosis code are

24
times higher
than in patients without these conditions.
Adjusted odds of
a CKD diagnosis Medicare
2.1
3.6
2.5
Diabetes
Hypertension
Cardiovascular disease
MarketScan
3.3
3.3
2.8
Prevalence of CKD: Figures 2.
Recognition of CKD: Figures 2.
Microalbumin testing: Figure 2.
Odd of CKD diagnosis: Table 2.f
8.+% z.% +z.8% c.z% c.6% c.)% c.8+% +.y%
page
19
0 100 200 300 400 500
Stage 1-2
Stage 3
Stage 4-5
Hospitalizations per
1,000 patient years
560
438
407
0 20 40 60 80 100
.
Deaths per 1,000
patient years
105
62
66
Stage 1-2
Stage 3
Stage 4-5
.++. 1+-, 1--- .
|- .|. :|-|:
Medicare patients age and older are twice as likely to see a cardioIogist as a
nephroIogist following any diagnosis for CkD. Among patients with a CkD diagnosis of
Stage or higher, approximateIy two-thirds see either a cardioIogist or nephroIogist.
Patients who
see a primary
care physician 93% 93%
63%
31%
Patients
who see a
cardiologist
Patients
who see a
nephrologist
All CKD CKD code of 585.3 or higher
63%
65%
Hospitalization rates
Mortality rates
CKD stage
No CkD
No CkD
AII CkD
AII CkD
40% HIGHER
39% HIGHER
adjusted all
-
cause hospitalization and mortality rates
are higher in ckd patients
than in those without the disease
+8
yq
qqq
)y
Physician care: Tables 2.gh
Hospitalization: Table .a
Mortality: Table .c
CHF 19.5%
CVA/TIA 20.2%
AMI 6.0%
CHF 44.2%
CVA/TIA 26.5%
AMI 12.8%
No CKD CKD
CKD: $31.6 billion
Medicare total:
$225 billion
1% CKD + diabetes: $17 billion
Medicare diabetes: $72.1 billion
CKD + CHF: $15.5 billion
Medicare CHF: $48.7 billion
57% of Stage 3 CKD patients with CHF, and 48%
of Stage 45 CKD patients with CHF,
receive an
acei/arb
67% of CKD patients with CHF
receive a
beta blocker

|.t|orts .|t| || c...y . |..go. bJ.Jor c|
c..J|cv.scJ|.. J|so.so t|.r t|cso .|t|cJt ||
Days supply: top three drugs used by
Medicare Part D enrollees with CKD
92.8 million
Furosemide
82.7 million
Metoprolol
66.6 million
Levothyroxine
Costs: top three drugs used by
Medicare Part D enrollees with CKD
$216 million
Insulin
$148 million
Clopidogrel bisulfate
$104 million
Atorvastatin
4.7% 6.2%
3.0% 4.3%
3.2% 3.0%
11.9%
of total Medicare
Part D drug use
13.5%
of total Medicare
Part D drug costs
NET PART D COSTS
FOR MEDICARE CKD
PATIENTS IN 2008
$3.46
billion
JANUARY 1, 2006: MEDICARE PART D GOES INTO EFFECT
to help subsidize the costs of prescription drugs in Medicare benefciaries
Circle diagram: Figure .1
ACE/ARB & beta blocker use: Table .b
Medication frequency & cost: Figures .2021
Total Part D costs: Figure .11
Costs of patient care: Figure .
Costs of caring
for patients with
CKD in 2008
Overall, CKD patients
account for 14% of total
Medicare expenditures
CKD patients with diabetes
account for 23.5% of Medicare
diabetes expenditures
CKD patients with congestive
heart failure account for 32%
of Medicare CHF expenditures
2011
USRDS
ANNUAL
DATA
REPORT
volume
one
ckd
page
20
0 100 200 300 400 500
Stage 1-2
Stage 3
Stage 4-5
Hospitalizations per
1,000 patient years
560
438
407
0 20 40 60 80 100
.
Deaths per 1,000
patient years
105
62
66
Stage 1-2
Stage 3
Stage 4-5
.++. 1+-, 1--- .
|- .|. :|-|:
Medicare patients age and older are twice as likely to see a cardioIogist as a
nephroIogist following any diagnosis for CkD. Among patients with a CkD diagnosis of
Stage or higher, approximateIy two-thirds see either a cardioIogist or nephroIogist.
Patients who
see a primary
care physician 93% 93%
63%
31%
Patients
who see a
cardiologist
Patients
who see a
nephrologist
All CKD CKD code of 585.3 or higher
63%
65%
Hospitalization rates
Mortality rates
CKD stage
No CkD
No CkD
AII CkD
AII CkD
40% HIGHER
39% HIGHER
adjusted all
-
cause hospitalization and mortality rates
are higher in ckd patients
than in those without the disease
+8
yq
qqq
)y
Physician care: Tables 2.gh
Hospitalization: Table .a
Mortality: Table .c
CHF 19.5%
CVA/TIA 20.2%
AMI 6.0%
CHF 44.2%
CVA/TIA 26.5%
AMI 12.8%
No CKD CKD
CKD: $31.6 billion
Medicare total:
$225 billion
1% CKD + diabetes: $17 billion
Medicare diabetes: $72.1 billion
CKD + CHF: $15.5 billion
Medicare CHF: $48.7 billion
57% of Stage 3 CKD patients with CHF, and 48%
of Stage 45 CKD patients with CHF,
receive an
acei/arb
67% of CKD patients with CHF
receive a
beta blocker

|.t|orts .|t| || c...y . |..go. bJ.Jor c|
c..J|cv.scJ|.. J|so.so t|.r t|cso .|t|cJt ||
Days supply: top three drugs used by
Medicare Part D enrollees with CKD
92.8 million
Furosemide
82.7 million
Metoprolol
66.6 million
Levothyroxine
Costs: top three drugs used by
Medicare Part D enrollees with CKD
$216 million
Insulin
$148 million
Clopidogrel bisulfate
$104 million
Atorvastatin
4.7% 6.2%
3.0% 4.3%
3.2% 3.0%
11.9%
of total Medicare
Part D drug use
13.5%
of total Medicare
Part D drug costs
NET PART D COSTS
FOR MEDICARE CKD
PATIENTS IN 2008
$3.46
billion
JANUARY 1, 2006: MEDICARE PART D GOES INTO EFFECT
to help subsidize the costs of prescription drugs in Medicare benefciaries
Circle diagram: Figure .1
ACE/ARB & beta blocker use: Table .b
Medication frequency & cost: Figures .2021
Total Part D costs: Figure .11
Costs of patient care: Figure .
Costs of caring
for patients with
CKD in 2008
Overall, CKD patients
account for 14% of total
Medicare expenditures
CKD patients with diabetes
account for 23.5% of Medicare
diabetes expenditures
CKD patients with congestive
heart failure account for 32%
of Medicare CHF expenditures
page
21
2011
USRDS
ANNUAL
DATA
REPORT
volume
one
ckd
page
22
introduction to volume one ckd
and other comorbidities, adverse events, preventive care,
prescription medication therapy, and costs to Medicare and
employer group health plans. In Volume Two we provide
information on the size and impact of the end-stage renal
disease (ESRD) population the traditional focus of the
USRDS presenting an overview of the ESRD program, along
with detailed data on incidence, prevalence, comorbidity of
new ESRD patients, severity of disease, clinical care, hospi-
talization and mortality rates, pediatric patients, renal trans-
plantation, the provider delivery system, and the economics
of the ESRD program.
Te ADR has been shortened this year due to budgetary
limitations, and the CKD and ESRD volumes have been bound
together into one book. Chapters in the CKD volume have
been limited to three or four spreads, and previous chapters
on cognitive function, the transition to ESRD, and acute kid-
ney injury have been omitted.
Tis years ADR presents data on the breadth of kidney
disease and its impact on both individuals and society as a
whole. To explore this idea, we turn this year to one of the
most human characteristics of all the ability to express our-
selves through music. In the wide diversity of musical expres-
sion we see similarities to the far-ranging impact of kidney
disease across diferent racial and ethnic populations; in the
lyrics of American music of the twentieth century ranging
from the Big Band era to folk music of the 1960s we see
expressions of emotion that can illustrate how kidney disease
touches patients and their loved ones. Te emotional impli-
cations of life with kidney disease, particularly for those on
dialysis, are substantial, and relate not only to the physical
elements of the disease but to its enormous fnancial stresses
and its impact on personal relationships. Understanding
these broad implications, we hope that the emotional con-
nections expressed through American music help frame our
reporting on kidney disease in the United States.
We approach Volume One from the perspective that the
implications of CKD were under-appreciated prior to Feb-
ruary, 2002, when a new CKD classifcation staging system
was proposed. Te fve-stage system was developed using
population-level data from the National Health and Nutri-
tion Examination Survey (NHANES), a surveillance system
coordinated by the National Center for Health Statistics at
the Centers for Disease Control and Prevention. Te concep-
tual model of this system was based on similar approaches
This is the twenty
-
third annual report of the United
States Renal Data System, and the twelfth in our atlas
series. For the fourth year we include a volume on
chronic kidney disease (CKD), defining its burden in the
general population, and looking at cardiovascular
page
23
for populations at risk for diabetes and hypertension, two
well-known diseases that damage the kidney as well as other
organ systems. Te model characterizes progressive stages
of CKD, from early evidence of kidney damage such as
albumin in the urine to overt reductions in the fltering
capacity of the kidney, defned by the estimated glomerular
fltration rate (eGFR).
There are many issues related to defining the levels of
eGFR and urine albumin which indicate true disease in
the kidney during the early stages of CKD, as compared to a
normal reduction in kidney fltering capacity (particularly
in the elderly). Improving on the MDRD method, a new esti-
mating formula the CKD-EPI equation was published in
the Annals of Internal Medicine in May, 2009; we compare
these two equations, providing a perspective for readers on
the strengths and weaknesses of each.
While the USRDS and others will continue to investigate
these issues in both the clinical and public health arenas,
already there are important data available on the impact of
CKD, data based both on biochemical information and on
the defnition of the disease within the Medicare and health
plan datasets. Te impact of the CKD staging system as a pre-
dictor of morbidity and mortality is now well known on a
population level, but its translation into the care of individual
patients must continue to evolve to help clinicians provide
the best care to their patients afected by kidney disease.
In the Prcis we highlight some of the most important
data from the chapters, and address the burden of CKD an
area of major public policy and public health concern. In
Chapter One we then define the CKD population, using
NHANES data to examine how chronic conditions such as
diabetes and congestive heart failure interact with CKD in
a random sample of the U.S. population. We compare CKD
populations identifed through the MDRD and CKD-EPI equa-
tions, and address the burden of CKD across age, gender, and
racial groups, as well as among patients with other chronic
diseases. We also examine awareness, treatment, and control
of hypertension, diabetes, and lipid disorders, and conclude
with mortality prediction models, using both the MDRD and
CKD-EPI equations.
Using data from the Medicare claims system and the
employer group health plan datasets, we consolidate data
on identifcation and care of CKD patients into Chapter Two.
We begin by summarizing basic descriptive and comor-
bidity information from the major datasets used by the
USRDS the 5 percent Medicare sample, and the MarketScan
and Ingenix i3 databases. We then illustrate the actual CKD
burden in the NHANES population, and show that data
gleaned only from the 585 diagnosis codes under-reports this
burden. Data on laboratory testing of at-risk patients show
that rates of evaluation for kidney disease through urine
microalbumin and serum creatinine testing are low. We
conclude the chapter by looking at the likelihood of receiving
nephrologist care afer a CKD diagnosis, and at prescription
drug therapy among patients with CKD.
In Chapter Three we address morbidity and mortality
among patients with CKD. We begin with comparisons of
hospitalization rates in CKD and non-CKD patients, looking
both at all-cause hospitalizations and at those for cardiovas-
cular disease and infection, and giving particular attention
to hospitalizations for infection. We conclude with data on
mortality rates by CKD stage and across risk groups.
Cardiovascular disease in the CKD population is the focus
of Chapter Four, in which we evaluate, by CKD stage, major
cardiovascular diagnoses and interventions, medication
use, survival, and hospitalization. Data on prescription drug
therapy are obtained from the Medicare Part D database, and
address recommended therapies for major cardiovascular
diagnoses and for patients receiving certain revasculariza-
tion procedures.
This year we have added a chapter on Medicare Part D
prescription drug use to both the CKD and ESRD volumes,
defning the populations using the beneft and looking at
various types of coverage, including the low income subsidy
(LIS). We begin by looking at enrollment patterns in the gen-
eral Medicare and CKD populations, then present data on
monthly premiums, deductibles, gap coverage, and copay-
ments. Data on the costs of Part D enrollment show total
expenditures and per person per year (PPPY) costs; we also
look at costs of specifc medications in the general Medicare
population and among those with early- or late-stage CKD.
And, because CKD patients use substantial amounts of pre-
scription drugs, we also look at their likelihood of reaching
the coverage gap compared to that of their counterparts in
the general Medicare population.
We conclude the CKD volume with Chapter Six, addressing
the costs associated with CKD. We look at PPPY costs in the
CKD population as a whole and in those with diabetes or car-
diovascular disease, examine components of costs for CKD
patients, and detail Medicare Part D costs by CKD stage, race,
and LIS status.
Data presented in this volume illustrate the challenges that
CKD, its complications, and its costs pose to the healthcare
system, to policy makers, and to the individuals and fami-
lies facing this condition. Programs to detect CKD some of
which have been ongoing since 2000 have been initiated
by the CDC and by non-proft patient organizations. By their
nature, detection programs are broad-based approaches to
continued on page 26
Director
Allan Collins, MD
Deputy Director
Robert Foley, MB, MSc
Data management,
computer systems,
& quality
Shu-Cheng Chen, MS
Co-investigators ADR editorial
production
Susan Everson, PhD
Business operations
Minneapolis Medical
Research Foundation
Kim Miller
Epidemiology
Robert Foley, MB, MSc
Areef Ishani, MD, MS
Marshall McBean,
MD, MSc
Jon Snyder, PhD
Medicine
Blanche Chavers, MD
Charles Herzog, MD
Bertram Kasiske, MD
Anne Murray, MD, MSc
Wendy St. Peter, PharmD
Health policy
& economics
Suying Li, PhD
Lih-Wen Mau, PhD
Craig Solid, PhD
Biostatistics
David Gilbertson, PhD
Jiannong Liu, PhD
Eric Weinhandl, MS
National Institute of
Diabetes & Digestive &
Kidney Diseases (NIDDK)
National Institutes
of Health (NIH)
Division of Kidney,
Urologic, & Hematologic
Diseases (DKUHD)
Project
Ocers
Steering
Committee
USRDS
Coordinating Center
USRDS Special
Studies Centers
Data Request Review Committee
Renal Community Council
Special Studies Review &
Implementation Committee
External
Advisory
Committee
Centers for
Medicare &
Medicaid Services
2011
USRDS
ANNUAL
DATA
REPORT
volume
one
ckd
page
24
introduction to volume one ckd
I
a
USRDS
contacts
I
1
Administrative
oversight of the USRDS
I
b
Departmental organization
of the Special Studies Centers
I
2
Departmental organization
of the Coordinating Center
Cardiovascular
Special Studies
Charles Herzog, MD
Director
Blanche Chavers, MD
Deputy Director
Robert Foley, MB, MSc
Co-investigator
David Gilbertson, PhD
Shuling Li, MS
Craig Solid, PhD
Biostatistics
Nutrition
Special Studies
Kirsten Johansen, MD
Director
George Kaysen, MD, PhD
Deputy Director
Glenn Chertow, MD, MPH
Manjula Tamura, MD
Stefanos Zenios, MD
Co-Investigators
Barbara Grimes
Su-Chun Chen, DSc
Charles McCulloch, PhD
Epidemiology & Biostatistics
Rehabilitation & Quality
of Life Special Studies
Nancy Kutner, PhD
Director
Kirsten Johansen, MD
Deputy Director
Haimanot Wasse, MD
Nephrology
Yijian Huang, PhD
Rebecca Zhang, MS
Biostatistics
Tess Bowles, MEd
Research Coordinator
CC data requests
612.347.7776 or
1.888.99USRDS;
usrds@usrds.org
CC data fles
Shu-Cheng Chen, MS, MPH
schen@usrds.org
Website, RenDER
Eric Frazier, BS
Stephan Dunning, MGIS
webmaster@usrds.org
Director, Cardiovascular
Special Studies Center (SSC)
Charles Herzog, MD
cherzog@usrds.org
Director, Nutrition SSC
Kirsten Johansen, MD
Kirsten.Johansen@ucsf.edu
Director, Rehabilitation
& Quality of Life SSC
Nancy Kutner, PhD
nkutner@emory.edu
Co-Project Ofcer, USRDS
Lawrence Y.C. Agodoa, MD
NIDDK
2 Democracy, Room 653
6707 Democracy Blvd
Bethesda, MD 20892-5454
Phone 301.594.1932
Fax 301.594.9358
agodoal@extra.niddk.nih.gov
Co-Project Ofcer, USRDS
Paul W. Eggers, PhD
NIDDK
2 Democracy, Room 615
6707 Democracy Blvd
Bethesda, MD 20892-5454
Phone 301.594.8305
Fax 301.480.3510
eggersp@extra.niddk.nih.gov
USRDS Coordinating
Center (CC)
914 South 8th Street
Suite S-206
Minneapolis, MN 55404
Phone 612.347.7776
Toll-free 1.888.99USRDS
Fax 612.347.5878
www.usrds.org
CC Director
Allan J. Collins, MD, FACP
acollins@usrds.org
CC Deputy Director
Robert N. Foley, MB, MSc
rfoley@usrds.org
USRDS database
(2.26 million patients)
ESRD
cohort
nder les
USRDS Annual
Data Report
Data
analyses
USRDS custom
data les
USRDS researcher
SAF CDs
Patient
prole
Comorbidity
prole
Tx
prole
CMS ESRD & 5% general
Medicare Claims data:
EPO & Parts A, B, & D
UNOS
transplant
data
Modality/
payor
sequence
USRDS Special
Studies data
Disease-specic
cohort nder les
(CKD, CHF, DM)
EGHP claims
data:
Parts A & B
CMS ESRD Part B SAF
claims: Physician/
Supplier, DME
CMS ESRD Part A SAF
claims: OP, IP,
SNF, HH, hospice
5% general Medicare
SAF claims: OP, IP, SNF,
HH, hospice, physician/
supplier, DME
CMS
PMMIS/
REBUS/REMIS
CMS ESRD
& 5%
Part D
data
Ingenix i3
& MarketScan
enrollment
& claims data
NHANES UNOS
tx
data
CMS
ESRD
facility
data
USRDS web-based
applications
CDC
survey
data
Network
SIMS
Common Standard Re-usable Working Set Library
National Institute of Diabetes
& Digestive & Kidney Diseases (NIDDK)
Robert Star, MD
Director, Division of Kidney, Urologic,
& Hematologic Diseases (DKUHD)
Lawrence Y.C. Agodoa, MD
Co-Project Ofcer, USRDS; Director,
End-Stage Renal Disease Program
Paul W. Eggers, PhD
Co-Project Ofcer, USRDS; Program Director,
Kidney & Urology Epidemiology
April Merriwether
Contract Specialist, NIH/NIDDK
Centers for Medicare
& Medicaid Services (CMS)
Diane L. Frankenfeld, DrPH
Senior Research Analyst, Division of Research
on Health Plans & Drugs (DRHPD), Research
& Evaluation Group, Ofce of Research,
Development, & Information (ORDI)
Mary Teresa Casey, RD, LD
Manager, ESRD Network Program, & Director,
Division of Quality Improvement Policy for
Chronic and Ambulatory Care (DQIPCAC),
Quality Improvement Group, Ofce of Clinical
Standards and Quality (OCSQ)
Patrick Conway, MD
CMS Chief Medical Ofcer & Director, OCSQ
Debbie Hattery
Director, Information System Group, OCSQ
USRDS Coordinating Center (CC) &
Special Studies Centers (SSCs)
Allan J. Collins, MD, FACP
CC Director; Professor of Medicine, University
of Minnesota (U of MN) School of Medicine;
Nephrologist, Department of Medicine,
Hennepin County Medical Center (HCMC)
Robert Foley, MB, MSc
CC Deputy Director;
Associate Professor of Medicine,
U of MN School of Medicine
Charles Herzog, MD
Director, Cardiovascular SSC;
Staf Cardiologist, Department of Medicine, HCMC;
Professor of Medicine, U of MN School of Medicine
Kirsten Johansen, MD
Director, Nutrition Special Studies Center;
Associate Professor in Residence, Nephrology,
University of California at San Francisco
Nancy Kutner, PhD
Director, Rehabilitation &
Quality of Life Special Studies Center;
Professor of Rehabilitation Medicine,
Emory University Medical School
USRDS CC Co-Investigators
Blanche Chavers, MD
Professor of Pediatrics,
U of MN School of Medicine
David Gilbertson, PhD
Director, Epidemiology & Biostatistics, USRDS
Charles Herzog, MD
Staf Cardiologist, Department of Medicine, HCMC;
Professor of Medicine, U of MN School of Medicine
Areef Ishani, MD, MS
Clinical Scholar, Center for Epidemiology & Clinical
Research; Assistant Professor of Medicine, VA
Medical Center (Minneapolis) & U of MN School
of Medicine
Bertram Kasiske, MD
Professor of Medicine, U of MN School of Medicine;
Chief of Nephrology, Department of Medicine,
HCMC
Suying Li, PhD
Health policy, USRDS
Jiannong Liu, PhD
Biostatistics, USRDS
Lih-Wen Mau, PhD
Health policy, USRDS
Marshall McBean, MD, MSc
Professor & Department Head,
Department of Health Management & Policy,
U of MN School of Public Health
Anne Murray, MD, MSc
Associate Professor of Medicine,
U of MN School of Medicine;
Staf Geriatrician, HCMC
Wendy St. Peter, PharmD, BCPS
Professor, U of MN College of Pharmacy;
Department of Medicine, HCMC
Jon Snyder, PhD
Epidemiology, USRDS; Adjunct Assistant Professor,
U of MN School of Public Health
Craig Solid, PhD
Economics, USRDS
page
25
I
3
Structure of the
USRDS database
I
c
USRDS
members
Throughout the ADR, with the exception of
NHANES data, CKD cohorts exclude ESRD patients.
8.2 9.2 9.9 10.8
7.6 12.2
Josef Coresh, MD, PhD
Chairman
Lawrence Agodoa, MD
Paul Eggers, PhD
Robert Star, MD
NIDDK
Diane Frankenfeld, DrPH
Mary Teresa Casey, RD, LD
Centers for Medicare
& Medicaid Services
Allan Collins, MD
(non-voting)
USRDS
Janice Lea, MD
Lesley Inker, MD
CKD
Robert Ettenger, MD
Pediatric nephrology
Rajiv Agarwal, MBBS,
MD, FAHA, FASN
Adult nephrology
Robert S. Woodward, PhD
Health economics
Tom Greene, PhD
Biostatistics
Stacey FitzSimmons, PhD
Lynda Anne Szczech, MD,
MSCE
Epidemiology
T. Alp Ikizler, MD
Hemodialysis
Alexander Goldfarb-
Rumyantzev, MD
Peritoneal dialysis
Jordan Cohen, MD
At large
Klemens Meyer, MD
ESRD Network Forum
Administrative staf
Beth Forrest, BBA; Dana Knopic, AAS; Tara Rogan, BA
ADR production
Edward Constantini, MA; Susan Everson, PhD
Biostatistics
Haifeng Guo, MS; Sally Gustafson, MS; Brooke Heubner, MS; Kenneth
Lamb, PhD; Shuling Li, MS; Suying Li, PhD; Yi Peng, MS; Yang Qiu, MS;
Tricia Roberts, MS; Melissa Skeans, MS; Bryn Thompson, BA;
Changchun Wang, MS; Eric Weinhandl, MS; David Zaun, MS
Information systems & software development
Cheryl Arko, BA; Shu-Cheng Chen, MS, MPH; Frank Daniels, BS;
James Ebben, BS; Eric Frazier, BS; Christopher Hanzlik, BS;
Roger Johnson; C Daniel Sheets, BS; Xinyue Wang, BA/BS
Manuscripts
Nan Booth, MSW, MPH; James Kaufmann, PhD
2011
USRDS
ANNUAL
DATA
REPORT
volume
one
ckd
page
26
introduction to volume one ckd
defne, through the use of simple tests, populations at risk
of a disease or its complications, targeting individuals for
detailed evaluation and intervention. Te data we present
here indicate that the CKD population is under-recognized,
and that care of CKD patients is less than expected based
on clinical practice guidelines; both issues may contrib-
ute to the increased morbidity and mortality of this high-
risk population.
Beginning in 2010 (with codes for services implemented in
July, 2010), the CKD education beneft is intended to improve
access to care, modality selection, consideration of home
therapies, access to preemptive transplant, vascular access
planning, management of risk factors, and referral to nephrol-
ogists and nutritional counseling for those with Stage 4 CKD.
We plan to follow trends in these key aspects of care to deter-
mine the impact of this new beneft, and to examine how it
might afect the high frst-year mortality among hemodialy-
sis patients.
Te Researchers Guide, USRDS database, and administra-
tive oversight of the usrds are described in the introduction
to Volume Two.
Maps in the ADR present data divided into quintiles. In
the sample map on this page, for example, approximately
one-fifth of all data points have a value of 10.8 or above.
Ranges include the number at the lower end of the range,
and exclude that at the upper end (i.e, the second range here
is 8.2<9.2). To facilitate comparisons of maps for diferent
periods, we commonly apply a single legend to each map
in a series. In this case the data in each individual map are
not evenly distributed, and a map for a single year may not
contain all listed ranges. Numbers in the frst and last boxes
indicate the mean values of data points in the highest and
lowest quintiles; these can be used to calculate the percent
variation between quintiles.
Te Excel page for each map (on our website and CD-ROM)
includes additional data. Te map-specifc mean is calculated
using only the population included in the map; this will usu-
ally not match data presented elsewhere in the ADR, and
should be quoted with caution. Te overall mean includes
all patients for whom data are available, whether or not their
residency is known. We also include the number of patients
excluded in the map-specifc mean, and the total number of
patients used for the overall calculation.
I
d
Members of the External
Advisory Committee
I
e
USRDS Coordinating
Center staf