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Chronic Kidney Disease Data Details

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  • CKD-1 Reduce the proportion of the U.S. population with chronic kidney disease

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    National Health and Nutrition Examination Survey
    Changed Since the Healthy People 2020 Launch: 
    Yes
    Measure: 
    percent (age adjusted—see Comments)
    Baseline (Year): 
    14.8 (2001–06)
    Target: 
    13.3
    Target-Setting Method: 
    10 percent improvement
    Numerator: 

    Number of persons aged 18 years and over with chronic kidney disease stages 1-4

    Denominator: 

    Number of persons aged 18 years and over with measured urinary albumin/creatinine ratio (ACR) and information to compute estimated glomerular filtration rate (eGFR)

    Comparable Healthy People 2010 Objective: 
    Not applicable
    Data Collection Frequency: 
    Periodic
    Methodology Notes: 

      Chronic kidney disease (CKD) stages 1-4 defined as urinary albumin/creatinine ratio (ACR) = 30 mg/g (single measurement) or estimated glomerular filtration rate (eGFR) between 15 and 59 ml/min/1.73 m².

      The estimated glomerular filtration rate (eGFR) was computed using the Modification of Diet in Renal Disease (MDRD) study equation.Single albumin/creatinine ratio ACR measurement was used (all measurements in mg/g).

      Age Adjustment Notes: 

      This Indicator uses Age-Adjustment Groups:

      • Total: 18-44, 45-64, 65+
      • Sex: 18-44, 45-64, 65+
      • Race/Ethnicity: 18-44, 45-64, 65+
      • Educational Attainment: 25-44, 45-64, 65+
      • Family Income (percent poverty threshold): 18-44, 45-64, 65+
      • Country of Birth: 18-44, 45-64, 65+
      • Disability Status: 20-44, 45-64, 65+
      • Health Insurance Status: 18-44, 45-64
      • Marital Status: 20-44, 45-64, 65+
      • Veteran Status: 18-44, 45-64, 65+
      • Obesity Status: 20-44, 45-64, 65+

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch: 
    In 2015, the original 1999-2004 baseline of 15.1% was replaced with the 2001-2006 estimate (14.8%) to be more consistent with the baselines of other CKD objectives. The target was adjusted from 13.6% to 13.3% to reflect the revised baseline using the original target-setting method.

    References

    Additional resources about the objective

    1. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999; 130:461-70.
  • CKD-2 Increase the proportion of persons with chronic kidney disease (CKD) who know they have impaired renal function

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    National Health and Nutrition Examination Survey
    Changed Since the Healthy People 2020 Launch: 
    Yes
    Measure: 
    percent (age adjusted—see Comments)
    Baseline (Year): 
    9.4 (2001–06)
    Target: 
    13.4
    Target-Setting Method: 
    4 percentage point improvement
    Target-Setting Method Justification: 
    The baseline awareness among adults aged 45 years and older with chronic kidney disease (stages 1 through 4) was 9.4 percent (2001-2006). Clinically, a 4-percentage point improvement increase is reasonable.
    Numerator: 

    Number of persons aged 45 years and over with chronic kidney disease stages 1-4, who report having been told by a health professional that they have impaired kidneys

    Denominator: 

    Number of persons aged 45 years and over with chronic kidney disease stages 1-4

    Comparable Healthy People 2010 Objective: 
    Not applicable
    Questions Used to Obtain the National Baseline Data: 

      From the 2001-2006 National Health and Nutrition Examination Survey:

      [NUMERATOR AND DENOMINATOR:]

      {Have you/Has SP} ever been told by a doctor or other health professional that {you/s/he} had weak or failing kidneys? Do not include kidney stones, bladder infections, or incontinence.

      1. Yes
      2. No
      3. Don't know
      4. Refused
    Data Collection Frequency: 
    Periodic
    Methodology Notes: 

      Chronic kidney disease (CKD) stages 1-4 are defined as a urinary albumin/creatinine ratio (ACR) >30 mg/g (single measurement) or estimated glomerular filtration rate (eGFR) between 15 and 59 ml/min/1.73 m². The eGFR is computed using the Modification of Diet in Renal Disease (MDRD) study equation.

      Persons were considered to be aware that they have impaired renal function if they answered "yes" to the awareness question. Persons who did not respond to the awareness question (responses of "refused" and "unknown") were excluded from the analysis.

      Age Adjustment Notes: 

      This Indicator uses Age-Adjustment Groups:

      • Total: 45-64, 65+
      • Sex: 45-64, 65+
      • Race/Ethnicity: 45-64, 65+
      • Educational Attainment: 45-64, 65+
      • Family Income (percent poverty threshold): 45-64, 65+
      • Country of Birth: 45-64, 65+
      • Disability Status: 45-64, 65+
      • Marital Status: 45-64, 65+
      • Veteran Status: 45-64, 65+
      • Obesity Status: 45-64, 65+

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch: 
    In 2015, the original 1999-2004 baseline of 7.3% was replaced with 2001-2006 estimate (9.4%) to be more consistent with the baselines of other CKD objectives. The target was adjusted from 11.3% to 13.4% to reflect the revised baseline using the original target-setting method.

    References

    Additional resources about the objective

    1. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999; 130:461-70.
  • CKD-3 Increase the proportion of hospital patients who incurred acute kidney injury who have followup renal evaluation in 6 months post discharge

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    United States Renal Data System
    Changed Since the Healthy People 2020 Launch: 
    Yes
    Measure: 
    percent
    Baseline (Year): 
    11.2 (2007)
    Target: 
    12.3
    Target-Setting Method: 
    10 percent improvement
    Numerator: 

    Number of persons aged 65 years and over with an acute kidney injury hospitalization who have a microalbumin test within 6 months post discharge

    Denominator: 

    Number of persons aged 65 years and over with an acute kidney injury hospitalization

    Comparable Healthy People 2010 Objective: 
    Not applicable
    Data Collection Frequency: 
    Annual
    Methodology Notes: 

      The data are analyzed for Medicare patients aged 65 and over (5 percent of Medicare sample) with a hospitalized acute kidney injury (AKI) event in given year. Hospitalized AKI is defined by ICD-9-CM diagnosis code 584 in inpatient claims. Renal evaluation is identified by having a microalbumin test. Patients are followed from the discharge date to the earliest of the following dates: (1) death, (2) ESRD, (3) end of Medicare coverage, or (4) six months after the discharge date.

      CPT codes for urinary microalbumin measurement are identified from HEDIS 2008 specifications and include 82042, 82043, 82044, and 84156. (HEDIS 2008, a program of the National Committee for Quality Assurance (NCQA), is used to monitor the performance of managed health care plans.)

      The United States Renal Data System (USRDS) data, data collection procedures, calculation methods, and other technical information are included in the USRDS Annual Data Report.

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch: 
    In 2015, the original baseline was revised from 11.3 to 11.2 percent due to USRDS rates re-estimation. There is some lag in reporting new cases of ESRD. Therefore, each year’s Annual Data Report includes re-estimates of earlier year rates. For more information see the USRDS Annual Data Reports. The target was adjusted from 12.4 to 12.3 percent to reflect the revised baseline using the original target-setting method.

    References

    Additional resources about the objective

    1. More information on the analytic methods used to calculate these rates can be found in Appendix A of the USRDS Annual Data Report Atlas

    2. U.S. Renal Data System, USRDS 2012 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, 2012
  • CKD-4 Increase the proportion of persons with diabetes and chronic kidney disease who receive recommended medical evaluation

    • CKD-4.1 Increase the proportion of persons with chronic kidney disease who receive medical evaluation with serum creatinine, lipids, and microalbuminuria

      About the Data: National

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      United States Renal Data System
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      25.8 (2007)
      Target: 
      28.4
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of persons aged 65 years and over with chronic kidney disease who receive medical evaluation with serum creatinine, lipids, and microalbumin tests

      Denominator: 

      Number of persons aged 65 years and over with chronic kidney disease

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Methodology Notes: 

        The data to track this objective come from the United States Renal Data System (USRDS) 5% Medicare sample. Proper wording is microalbumin testing instead of microalbuminuria. The USRDS data, data collection procedures, calculation methods, and other technical information are included in the USRDS Annual Data Report.

      Changes Between HP2010 and HP2020: 
      This objective differs from Healthy People 2010 objective 4-8a which measured medical evaluation among persons aged 65 years and over with diabetes and chronic kidney disease (CKD). This objective tracks medical evaluation among all persons with CKD. The recommendations for medical evaluation of persons with CKD have been updated and currently include serum creatinine, lipids, and microalbumin tests. Consequently, data for this objective are not comparable with data for the Healthy People 2010 objective.

      About the Data: State

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the state-level data.

      Data Source: 
      United States Renal Data System
      Measure: 
      percent
      Numerator: 

      Number of persons aged 65 years and over with chronic kidney disease who receive medical evaluation with serum creatinine, lipids, and microalbumin tests

      Denominator: 

      Number of persons aged 65 years and over with chronic kidney disease

      Methodology Notes: 

          The data to track this objective come from the United States Renal Data System (USRDS) 5% Medicare sample. Proper wording is microalbumin testing instead of microalbuminuria. The USRDS data, data collection procedures, calculation methods, and other technical information are included in the USRDS Annual Data Report.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2018, the original baseline was revised from 25.9 to 25.8 percent due to USRDS rates re-estimation. There is some lag in reporting new cases of ESRD. Therefore, each year’s Annual Data Report includes re-estimates of earlier year rates. For more information see the USRDS Annual Data Reports. The target was adjusted from 28.5 to 28.4 percent to reflect the revised baseline using the original target-setting method.

      References

      Additional resources about the objective

      1. U.S. Renal Data System, USRDS 2012 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, 2012
    • CKD-4.2 Increase the proportion of persons with type 1 or type 2 diabetes and chronic kidney disease who receive medical evaluation with serum creatinine, microalbuminuria, A1c, lipids, and eye examinations

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      United States Renal Data System
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      23.0 (2007)
      Target: 
      25.3
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of persons aged 65 years and over with type 1 or type 2 diabetes and chronic kidney disease who receive medical evaluation with serum creatinine, microalbuminuria, A1c, lipids, and eye examinations

      Denominator: 

      Number of persons aged 65 years and over with type 1 or type 2 diabetes and chronic kidney disease

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        The data to track this objective come from the United States Renal Data System (USRDS) 5% Medicare sample. The methods and codes used to determine rates of glycosylated hemoglobin (A1c) testing and eye examinations are taken from the Health Effectiveness and Data Information Set (HEDIS) 2008 specifications. HEDIS 2008, a program of the National Committee for Quality Assurance (NCQA), is used to monitor the performance of managed health care plans.

        CPT codes 83036 and 83037 are used to identify A1c testing. Codes used to identify diabetic eye examinations are as follows: CPT codes, 92002, 92004, 92012, 92014, 92018, 92019, 92225, 92226, 92230, 92235, 92240, 92250, 92260, 67101, 67105, 67107, 67108, 67110, 67112, 67141, 67145, 67208, 67210, 67218, 67227, 67228, 67028, 67030, 67031, 67036, 67038, 67039, 67041, 67042, 67043, 67113, 67121, 67221, 67228, S0625, S0620, S0621, and S3000; ICD-9-CM procedure codes, 14.1–14.5, 14.9, 95.02, 95.03, 95.04, 95.11, 95.12, and 95.16; and ICD-9-CM diagnosis code V72.0.

        The USRDS data, data collection procedures, calculation methods, and other technical information are included in the USRDS Annual Data Report.

      Changes Between HP2010 and HP2020: 
      This objective differs from Healthy People 2010 objective 4-8a which measured medical evaluation among people with diabetes and chronic kidney disease (CKD). The recommendations for medical evaluation of persons with type 1 or type 2 diabetes and CKD have been updated and currently include serum creatinine and microalbuminuria tests in addition to A1c, lipids, and eye examinations. Consequently, data for this objective are not comparable with data for the Healthy People 2010 objective.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2013, the original baseline was revised from 23.1 to 23.0 percent due to USRDS rates re-estimation. There is some lag in reporting new cases of ESRD. Therefore, each year’s Annual Data Report includes re-estimates of earlier year rates. For more information see the USRDS Annual Data Reports. The target was adjusted from 25.4 to 25.3 percent to reflect the revised baseline using the original target-setting method.

      References

      Additional resources about the objective

      1. More information on the analytic methods used to calculate these rates can be found in Appendix A of the USRDS Annual Data Report Atlas.

      2. U.S. Renal Data System, USRDS 2012 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, 2012
  • CKD-5 Increase the proportion of persons with diabetes and chronic kidney disease who receive recommended medical treatment with angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBS)

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    United States Renal Data System
    Changed Since the Healthy People 2020 Launch: 
    Yes
    Measure: 
    percent
    Baseline (Year): 
    67.4 (2007)
    Target: 
    76.3
    Target-Setting Method: 
    10 percent improvement
    Numerator: 

    Number of persons aged 65 years and over with diabetes and chronic kidney disease who have at least one prescription for ACE and/or ARB

    Denominator: 

    Number of persons aged 65 years and over with diabetes and chronic kidney disease

    Comparable Healthy People 2010 Objective: 
    Adapted from HP2010 objective
    Methodology Notes: 

      Medication use is obtained from Part D prescription data in the Medicare 5% sample. The cohort includes general Medicare patients diagnosed with both diabetes and chronic kidney disease in each year, who are aged 65 years and over at the beginning of the year and continuously enrolled in the Medicare inpatient/outpatient and physician/supplier program during the entire year. In 2007–2010, patients are enrolled in Medicare Part D during the entire year. Use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBS) is defined by at least one prescription fill from either drug class during the year.

      The United States Renal Data System (USRDS) data, data collection procedures, calculation methods, and other technical information are included in the USRDS Annual Data Report.

    Changes Between HP2010 and HP2020: 
    This objective differs from Healthy People 2010 objective 4-8b which measured recommended medical management including the use of drugs that modify the renin-angiotensin-aldosterone system (RAAS), such as angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB). The recommendations for medical treatment of persons with type 1 or type 2 diabetes and CKD have been updated and currently include angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBS). Consequently, data for this objective are not comparable with data for the Healthy People 2010 objective.

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch: 
    In 2018, the original baseline was revised from 54.6 to 69.4 percent due to USRDS rates re-estimation. There is some lag in reporting new cases of ESRD. Therefore, each year’s Annual Data Report includes re-estimates of earlier year rates. For more information see the USRDS Annual Data Reports. The target was adjusted from 60.0 to 76.3 percent to reflect the revised baseline using the original target-setting method.

    References

    Additional resources about the objective

    1. More information on the analytic methods used to calculate these rates can be found in Appendix A of the USRDS Annual Data Report Atlas

    2. U.S. Renal Data System, USRDS 2012 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, 2012
  • CKD-6 Improve cardiovascular care in persons with chronic kidney disease

    • CKD-6.1 Reduce the proportion of persons with chronic kidney disease who have elevated blood pressure

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Health and Nutrition Examination Survey
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent (age adjusted—see Comments)
      Baseline (Year): 
      22.7 (2001–06)
      Target: 
      17.6
      Target-Setting Method: 
      Minimal statistical significance
      Target-Setting Method Justification: 
      Using minimal statistical significance would target a reduction in the measure of about 5 percentage points (rather than about 2 percentage points lower using the 10% improvement method).
      Numerator: 

      Number of persons aged 18 years and over with chronic kidney disease stages 1–4 with measured high systolic (≥140 mmHg) or diastolic (≥90 mmHg) blood pressure.

      Denominator: 

      Number of persons aged 18 years and over with chronic kidney disease stages 1–4 who have blood pressure measurements.

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        Chronic kidney disease (CKD) stages 1-4 are defined as a urinary albumin/creatinine ratio (ACR) >30 mg/g (single measurement) or estimated glomerular filtration rate (eGFR) between 15 and 59 ml/min/1.73 m². The eGFR is computed using the Modification of Diet in Renal Disease (MDRD) study equation.

        Adults are defined as having high blood pressure/hypertension if they have a measurement of mean systolic blood pressure (SBP) ≥140 mm Hg or (b) mean diastolic blood pressure (DBP) ≥90 mm Hg.

        Blood pressure is measured by averaging up to 3 blood pressure readings taken during the physical examination in the NHANES mobile examination center. A detailed description of the procedures for blood pressure measurement in the NHANES has been published elsewhere.

        Age Adjustment Notes: 

        This Indicator uses Age-Adjustment Groups:

        • Total: 18-44, 45-64, 65+
        • Sex: 18-44, 45-64, 65+
        • Race/Ethnicity: 18-44, 45-64, 65+
        • Educational Attainment: 25-44, 45-64, 65+
        • Family Income (percent poverty threshold): 18-44, 45-64, 65+
        • Country of Birth: 18-44, 45-64, 65+
        • Disability Status: 20-44, 45-64, 65+
        • Health Insurance Status: 18-44, 45-64
        • Marital Status: 20-44, 45-64, 65+
        • Veteran Status: 18-44, 45-64, 65+
        • Obesity Status: 20-44, 45-64, 65+

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2015, the measure was changed from the proportion of persons with CKD who have hypertension (including self-reported, and prescription) to the proportion of persons with CKD having uncontrolled hypertension (measured). The rationale for this revision was to have more meaningful and valid estimate as it relates to reducing uncontrolled hypertension and hence improving cardiovascular care in people with CKD. As a result, the baseline was revised from 54.7% (1999-2004) to 22.7% (2001-2006). The target-setting method was also revised from 10 percent improvement to minimal statistical significance and the target was adjusted from 49.2% to 17.6% to reflect the revised baseline.

      References

      Additional resources about the objective

      1. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999; 130:461-70.
    • CKD-6.2 Increase the proportion of adults aged 50 years and over with chronic kidney disease who currently take statins to lower their blood cholesterol

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Health and Nutrition Examination Survey
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent (age adjusted—see Comments)
      Baseline (Year): 
      21.6 (2001–06)
      Target: 
      25.6
      Target-Setting Method: 
      Minimal statistical significance
      Target-Setting Method Justification: 
      Using minimal statistical significance would target a reduction in the measure of about 5 percentage points (rather than about 2 percentage points lower using the 10% improvement method).
      Numerator: 

      Number of persons aged 50 years and over with chronic kidney disease stages 1-4 who reported currently taking statins to lower their blood cholesterol

      Denominator: 

      Number of persons aged 50 years and over with chronic kidney disease stages 1-4

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Questions Used to Obtain the National Baseline Data: 

        From the 2001-2006 National Health and Nutrition Examination Survey:

        [NUMERATOR:]

        To lower (your/his/her) blood cholesterol, (have/has) (you, SP) ever been told by a doctor or other health professional…to take prescribed medicine?

        1. Yes
        2. No
        3. Refused
        4. Don't know

        [If yes] (Are you/Is SP) now following this advice to take prescribed medicine?

        1. Yes
        2. No
        3. Refused
        4. Don't know
      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        Chronic kidney disease (CKD) stages 1-4 are defined as a urinary albumin/creatinine ratio (ACR) >30 mg/g (single measurement) or estimated glomerular filtration rate (eGFR) between 15 and 59 ml/min/1.73 m². The eGFR was computed using the Modification of Diet in Renal Disease (MDRD) study equation.

        Abnormal lipid values are defined in the Adult Treatment Plan III guidelines developed by the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults.

        Age Adjustment Notes: 

        This Indicator uses Age-Adjustment Groups:

        • Total: 50-64, 65+
        • Sex: 50-64, 65+
        • Race/Ethnicity: 50-64, 65+
        • Educational Attainment: 50-64, 65+
        • Family Income (percent poverty threshold): 50-64, 65+
        • Country of Birth: 50-64, 65+
        • Disability Status: 50-64, 65+
        • Health Insurance Status: 50-64
        • Marital Status: 50-64, 65+
        • Veteran Status: 50-64, 65+
        • Obesity Status: 50-64, 65+

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2015, the objective text was changed from “Reduce the proportion of persons with chronic kidney disease who have elevated lipid levels” to “Increase the proportion of persons aged 50 year and older with chronic kidney disease who currently take statins to lower their blood cholesterol.” The measure was changed from the proportion of persons with CKD and abnormal lipid values or reported prescription for statins to the proportion of persons with CKD and reported prescription for statins. The rationale for this change was to make the objective consistent with recommended patient care guidelines by the Kidney Disease Improving Global Outcomes Workgroup. Consequently, the baseline was revised from 28.4% (1999-2004) to 21.6% (2001-2006). The target-setting method was also revised from 10 percent improvement to minimal statistical significance and the target was adjusted from 25.4% to 25.6% to reflect the revised baseline.

      References

      Additional resources about the objective

      1. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999; 130:461-70.
      2. Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). National Cholesterol Education Program. National Heart, Lung, and Blood Institute National Institutes of Health NIH Publication No. 02-5215 September 2002.
  • CKD-7 Reduce the number of deaths among persons with chronic kidney disease

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    National Death Index
    National Health and Nutrition Examination Survey
    Changed Since the Healthy People 2020 Launch: 
    Yes
    Measure: 
    per 1,000 patient years (age adjusted—see Comments)
    Baseline (Year): 
    22.2 (1999-2004)
    Target: 
    Not applicable
    Target-Setting Method: 
    This measure is being tracked for informational purposes. If warranted, a target will be set during the decade.
    Target-Setting Method Justification: 
    The baseline of mortality among persons with chronic kidney disease (stages 1 through 4) was 2.5 per 100 person years (1988-94). Although improved health of the Nation is expected to lead to reduced deaths among individuals with chronic kidney disease, the reduction may not be sufficient to establish a target. The measure will be tracked over the decade, and a target may be added if changes in the death rate warrant.
    Numerator: 

    Number of deaths among persons aged 18 years and over with chronic kidney disease stages 1-4

    Denominator: 

    Person years of follow-up for persons aged 18 years and over with chronic kidney disease stages 1-4

    Comparable Healthy People 2010 Objective: 
    Not applicable
    Data Collection Frequency: 
    Periodic
    Methodology Notes: 

      Chronic kidney disease (CKD) stages 1-4 defined as urinary albumin/creatinine ratio (ACR) = 30 mg/g (single measurement) or estimated glomerular filtration rate (eGFR) between 15 and 59 ml/min/1.73 m². Estimated glomerular filtration rate (eGFR) was computed using the Modification of Diet in Renal Disease (MDRD) study equation.

      Single ACR measurement used (all measurements in mg/g). Follow-up time is from the National Health and Nutrition Examination Survey (NHANES) to the end of mortality follow-up. The baseline 1999-2004 NHANES data are linked to the National Death Index for mortality with follow up through 2011.

      Age Adjustment Notes: 

      This Indicator uses Age-Adjustment Groups:

      • Total: 18-24, 25-44, 45-64, 65+
      • Sex: 18-24, 25-44, 45-64, 65+
      • Race/Ethnicity: 18-24, 25-44, 45-64, 65+
      • Educational Attainment: 25-44, 45-64, 65+
      • Family Income (percent poverty threshold): 18-24, 25-44, 45-64, 65+
      • Country of Birth: 18-24, 25-44, 45-64, 65+
      • Health Insurance Status: 18-24, 25-44, 45-64
      • Stages of Chronic Kidney Disease: 18-24, 25-44, 45-64, 65+
      • Marital Status: 20-24, 25-44, 45-64, 65+
      • Veteran Status: 18-24, 25-44, 45-64, 65+
      • Obesity Status: 20-24, 25-44, 45-64, 65+

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch: 
    In 2015, the original 1988-1994 baseline was replaced with 1999-2004 estimate to be more consistent with the baseline of other CKD objectives. The measurement was changed from 100 to 1,000 patient years.

    References

    Additional resources about the objective

    1. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999; 130:461-70.
  • CKD-8 Reduce the number of new cases of end-stage renal disease (ESRD)

    About the Data: National

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    United States Renal Data System
    Changed Since the Healthy People 2020 Launch: 
    Yes
    Measure: 
    per 1,000,000 (age adjusted—see Comments)
    Baseline (Year): 
    391.2 (2007)
    Target: 
    352.0
    Target-Setting Method: 
    10 percent improvement
    Numerator: 

    Number of new patients requiring renal replacement therapy residing in U.S.

    Denominator: 

    Number of persons.

    Comparable Healthy People 2010 Objective: 
    Retained from HP2010 objective
    Data Collection Frequency: 
    Annual
    Methodology Notes: 

      The end-stage renal disease (ESRD) population includes dialysis and kidney transplant recipients. Qualification for renal replacement therapy is based on the submission of the Centers for Medicare and Medicaid Services (CMS) Medical Evidence Form (CMS-2728).

      The United States Renal Disease System (USRDS) uses data collected by the CMS. Since 1996, Health Care providers have been required to provide patient information on all persons with ESRD, regardless of health insurance.

      Adjustment by age/gender/race: Age-specific rates are adjusted for gender and race/ethnicity. Gender-specific rates are adjusted for age and race/ethnicity. Race/ethnicity-specific rates are adjusted for age and gender.

      Age Adjustment Notes: 

      This Indicator uses Age-Adjustment Groups:

      • Total: 0-4, 5-9, 10-14, 15-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60-64, 65-69, 70-74, 75-79, 80-84, 85+
      • Sex: 0-4, 5-9, 10-14, 15-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60-64, 65-69, 70-74, 75-79, 80-84, 85+
      • Race/Ethnicity: 0-4, 5-9, 10-14, 15-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60-64, 65-69, 70-74, 75-79, 80-84, 85+

    About the Data: State

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the state-level data.

    Data Source: 
    United States Renal Data System
    Measure: 
    per 1,000,000 (age adjusted—see Comments) (age adjusted—see Comments)
    Numerator: 

    Number of new patients requiring renal replacement therapy residing in U.S.

    Denominator: 

    Number of persons.

    Data Collection Frequency: 
    Annual
    Methodology Notes: 

        The end-stage renal disease (ESRD) population includes dialysis and kidney transplant recipients. Qualification for renal replacement therapy is based on the submission of the Centers for Medicare and Medicaid Services (CMS) Medical Evidence Form (CMS-2728).

        The United States Renal Disease System (USRDS) uses data collected by the CMS. Since 1996, Health Care providers have been required to provide patient information on all persons with ESRD, regardless of health insurance.

        Adjustment by age/gender/race: Age-specific rates are adjusted for gender and race/ethnicity. Gender-specific rates are adjusted for age and race/ethnicity. Race/ethnicity-specific rates are adjusted for age and gender.

      Age Adjustment Notes: 

      This Indicator uses Age-Adjustment Groups:

      • Total: 0-4, 5-9, 10-14, 15-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60-64, 65-69, 70-74, 75-79, 80-84, 85+
      • Sex: 0-4, 5-9, 10-14, 15-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60-64, 65-69, 70-74, 75-79, 80-84, 85+
      • Race/Ethnicity: 0-4, 5-9, 10-14, 15-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60-64, 65-69, 70-74, 75-79, 80-84, 85+

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch: 
    In 2018, the original baseline was revised from 353.8 to 391.1 per 1,000,000 due to USRDS rates re-estimation. There is some lag in reporting new cases of ESRD. Therefore, each year’s Annual Data Report includes re-estimates of earlier year rates. For more information see the USRDS Annual Data Reports. The target was adjusted from 318.5 to 352.0 per 1,000,000 to reflect the revised baseline using the original target-setting method.

    References

    Additional resources about the objective

    1. More information on the analytic methods used to calculate these rates can be found in Appendix A of the USRDS Annual Data Report Atlas.

    2. U.S. Renal Data System, USRDS 2012 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, 2012
  • CKD-9 Reduce kidney failure due to diabetes

    • CKD-9.1 Reduce kidney failure due to diabetes

      About the Data: National

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      United States Renal Data System
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      per 1,000,000 (age adjusted—see Comments)
      Baseline (Year): 
      171.5 (2007)
      Target: 
      154.4
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of end-stage renal disease patients in the U.S. whose cause of renal failure was due to diabetes.

      Denominator: 

      Number of persons in U.S.

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        The end-stage renal disease (ESRD) population includes dialysis and kidney transplant recipients. Qualification for renal replacement therapy is based on the submission of the Centers for Medicare and Medicaid Services (CMS) Medical Evidence Form (CMS-2728).

        The USRDS uses data collected by the CMS. Since 1996, Health Care providers have been required to provide patient information on all persons with ESRD, regardless of health insurance. Therefore, incident rates reflect the universe of ESRD cases in the United States. Three-year data are used to estimate the prevalence of diabetes in the middle year, and the size of the population with diabetes is based on U.S census data. The incident rate per million of ESRD caused by diabetes is calculated as the number of incident ESRD patients with a primary diagnosis of diabetes divided by the size of the population with diabetes in that group.

        Adjustment by age/gender/race: Age-specific rates are adjusted for gender and race/ethnicity. Gender-specific rates are adjusted for age and race/ethnicity. Race/ethnicity-specific rates are adjusted for age and gender.

        Age Adjustment Notes: 

        This Indicator uses Age-Adjustment Groups:

        • Total: 0-4, 5-9, 10-14, 15-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60-64, 65-69, 70-74, 75-79, 80-84, 85+
        • Sex: 0-4, 5-9, 10-14, 15-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60-64, 65-69, 70-74, 75-79, 80-84, 85+
        • Race/Ethnicity: 0-4, 5-9, 10-14, 15-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60-64, 65-69, 70-74, 75-79, 80-84, 85+

      About the Data: State

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the state-level data.

      Data Source: 
      United States Renal Data System
      Measure: 
      per 1,000,000 (age adjusted—see Comments) (age adjusted—see Comments)
      Numerator: 

      Number of end-stage renal disease patients in the U.S. whose cause of renal failure was due to diabetes.

      Denominator: 

      Number of persons in U.S.

      Data Collection Frequency: 
      Annual
      Methodology Notes: 

          The end-stage renal disease (ESRD) population includes dialysis and kidney transplant recipients. Qualification for renal replacement therapy is based on the submission of the Centers for Medicare and Medicaid Services (CMS) Medical Evidence Form (CMS-2728).

          The USRDS uses data collected by the CMS. Since 1996, Health Care providers have been required to provide patient information on all persons with ESRD, regardless of health insurance. Therefore, incident rates reflect the universe of ESRD cases in the United States. Three-year data are used to estimate the prevalence of diabetes in the middle year, and the size of the population with diabetes is based on U.S census data. The incident rate per million of ESRD caused by diabetes is calculated as the number of incident ESRD patients with a primary diagnosis of diabetes divided by the size of the population with diabetes in that group.

          Adjustment by age/gender/race: Age-specific rates are adjusted for gender and race/ethnicity. Gender-specific rates are adjusted for age and race/ethnicity. Race/ethnicity-specific rates are adjusted for age and gender.

        Age Adjustment Notes: 

        This Indicator uses Age-Adjustment Groups:

        • Total: 0-4, 5-9, 10-14, 15-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60-64, 65-69, 70-74, 75-79, 80-84, 85+
        • Sex: 0-4, 5-9, 10-14, 15-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60-64, 65-69, 70-74, 75-79, 80-84, 85+
        • Race/Ethnicity: 0-4, 5-9, 10-14, 15-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60-64, 65-69, 70-74, 75-79, 80-84, 85+

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2018, the original baseline was revised from 154.7 to 171.5 per 1,000,000 due to USRDS rates re-estimation. There is some lag in reporting new cases of ESRD. Therefore, each year’s Annual Data Report includes re-estimates of earlier year rates. For more information see the USRDS Annual Data Reports. The target was adjusted from 139.2 to 154.4 per 1,000,000 to reflect the revised baseline using the original target-setting method.

      References

      Additional resources about the objective

      1. More information on the analytic methods used to calculate these rates can be found in Appendix A of the USRDS Annual Data Report Atlas

      2. U.S. Renal Data System, USRDS 2012 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, 2012
    • CKD-9.2 Reduce kidney failure due to diabetes among persons with diabetes

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Health Interview Survey
      United States Renal Data System
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      per 1,000,000
      Baseline (Year): 
      2,614.2 (2007)
      Target: 
      2,354.4
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of end-stage renal disease patients in the U.S. whose cause of renal failure was due to diabetes

      Denominator: 

      Number of diabetic persons in U.S.

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From the 2007 National Health Interview Survey:

        [Denominator:]

        Other than during pregnancy, have you EVER been told by a doctor or health professional that you have diabetes or sugar diabetes?/Have you EVER been told by a doctor or health professional that you have diabetes or sugar diabetes?]

        1. Yes
        2. No
        3. Borderline
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        The end-stage renal disease (ESRD) population includes dialysis and kidney transplant recipients. Qualification for renal replacement therapy is based on the submission of the Centers for Medicare and Medicaid Services (CMS) Medical Evidence Form (CMS-2728).

        The USRDS uses data collected by the CMS. Since 1996, Health Care providers have been required to provide patient information on all persons with ESRD, regardless of health insurance. Therefore, incident rates reflect the universe of ESRD cases in the United States.

        The denominator uses data from the National Health Interview Survey (NHIS); all ages are included. Three-year data are used to estimate the prevalence of diabetes in the middle year, and the size of the population with diabetes is based on U.S census data. The incident rate per million of ESRD caused by diabetes is calculated as the number of incident ESRD patients with a primary diagnosis of diabetes divided by the size of the population with diabetes in that group.

      Changes Between HP2010 and HP2020: 
      This objective differs from Healthy People 2010 objective 4-7, which used incident count data on ESRD patients with diabetes among U.S. population. This objective measures ESRD cases among persons with diabetes. The number of persons who report ever being diagnosed with diabetes from the National Health Interview Survey, is as the Healthy People 2020 denominator.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2018, the original baseline was revised from 2,637.9 to 2,616.0 per 1,000,000 due to USRDS rates re-estimation. There is some lag in reporting new cases of ESRD. Therefore, each year’s Annual Data Report includes re-estimates of earlier year rates. For more information see the USRDS Annual Data Reports. The target was adjusted from 2,374.1 to 2,354.4 per 1,000,000 to reflect the revised baseline using the original target-setting method.

      References

      Additional resources about the objective

      1. More information on the analytic methods used to calculate these rates can be found in Appendix A of the USRDS Annual Data Report Atlas.

      2. U.S. Renal Data System, USRDS 2012 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, 2012
  • CKD-10 Increase the proportion of chronic kidney disease patients receiving care from a nephrologist at least 12 months before the start of renal replacement therapy

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    United States Renal Data System
    Changed Since the Healthy People 2020 Launch: 
    Yes
    Measure: 
    percent
    Baseline (Year): 
    27.3 (2007)
    Target: 
    30.0
    Target-Setting Method: 
    10 percent improvement
    Numerator: 

    Number of new chronic kidney disease patients who saw a nephrologist at least 12 months prior to starting renal replacement therapy

    Denominator: 

    Number of new chronic kidney disease patients

    Comparable Healthy People 2010 Objective: 
    Adapted from HP2010 objective
    Questions Used to Obtain the National Baseline Data: 

      From the CMS-2728 Medical Evidence Form:

      [NUMERATOR:]

      Prior to ESRD therapy, was patient under care of a nephrologist?

      1. Yes
      2. No
      3. Unknown

      If Yes, answer:

      1. 6-12 months
      2. >12 months
    Methodology Notes: 

      Qualification for renal replacement therapy is based on the submission of the Center for Medicare and Medicaid Services (CMS) Medical Evidence Form (CMS-2728). The cohorts include incident hemodialysis patients for whom it is known whether they saw a nephrologist prior to initiation.

      The United States Renal Data System (USRDS) data, data collection procedures, calculation methods, and other technical information are included in its Annual Data Report Atlas, Appendix A.

    Changes Between HP2010 and HP2020: 
    This objective differs from Healthy People 2010 objective 4-3, which measured number of treated chronic kidney failure patients who have received counseling on nutrition, treatment choices, and cardiovascular care 12 months before the start of renal replacement therapy. This objective tracks proportion of chronic kidney disease patients receiving care from a nephrologist at least 12 months before the start of renal replacement therapy using the CMS Medical Evidence Form (CMS-2728).

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch: 
    In 2015, the original baseline was revised from 27.1 to 27.3 percent due to USRDS rates re-estimation. There is some lag in reporting new cases of ESRD. Therefore, each year’s Annual Data Report includes re-estimates of earlier year rates. For more information see the USRDS Annual Data Reports. The target was adjusted from 29.8 to 30 percent to reflect the revised baseline using the original target-setting method.

    References

    Additional resources about the objective

    1. More information can be found in Appendix A of the USRDS Annual Data Report Atlas.

  • CKD-11 Improve vascular access for hemodialysis patients

    • CKD-11.1 Increase the proportion of adult hemodialysis patients who use arteriovenous fistulas as the primary mode of vascular access

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Clinical Performance Measures Project
      United States Renal Data System
      Changed Since the Healthy People 2020 Launch: 
      No
      Measure: 
      percent
      Baseline (Year): 
      46.0 (2006)
      Target: 
      50.6
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of persons aged 18 years and over who are reported to use arteriovenous (AV) fistula as the primary mode of vascular access

      Denominator: 

      Number of persons aged 18 years and over on hemodialysis

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From the in-center hemodialysis CMS Clinical Performance Measures data collection form CMS-820:

        [NUMERATOR:]

        What type of access was used on the last hemodialysis session on or between mm/dd/yyyy and mm/dd/yyyy at the patient’s primary in-center facility?

        1. AV Fistula
        2. Graft with AV Fistula
        3. Graft without AV Fistula
        4. Catheter
        5. Port Access
        6. Unknown
      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        Data from the Centers for Medicare and Medicaid Services (CMS) End Stage Renal Disease (ESRD) Clinical Performance Measures (CPM) project are used for this objective. Included patients are those whose date of dialysis initiation, according to the CPM data, occurs in the same year as the data collection, and access type represents the access used during the last quarter of the year, according to the CPM data.CPM is a CMS project developed to collect information on the quality of care provided to the ESRD dialysis patient. The data originates from surveys completed by the patients’ primary care facilities, which have been collected on a yearly basis, resulting in a rich source of detailed information useful in the analysis of health care delivery to the dialysis patient.

      Changes Between HP2010 and HP2020: 
      This objective differs from Healthy People 2010 objective 4-4, which tracked the use of arteriovenous fistulas as the primary mode of vascular access by new hemodialysis patients aged 20 years and over. This objective tracks use by all hemodialysis patients aged 18 years and over.

      References

      Additional resources about the objective

      1. More details on the methods used for calculating rates can be found in Appendix A of the USRDS Annual Data Report Atlas.

    • CKD-11.2 Reduce the proportion of adult hemodialysis patients who use catheters as the only mode of vascular access

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Clinical Performance Measures Project
      United States Renal Data System
      Changed Since the Healthy People 2020 Launch: 
      No
      Measure: 
      percent
      Baseline (Year): 
      29.0 (2006)
      Target: 
      26.1
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of persons aged 18 years and over who are reported to use a catheter as the only mode of vascular access.

      Denominator: 

      Number of persons in the study population aged 18 years and over on hemodialysis.

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From the in-center hemodialysis CMS Clinical Performance Measures data collection form CMS-820:

        [NUMERATOR:]

        What type of access was used on the last hemodialysis session on or between mm/dd/yyyy and mm/dd/yyyy at the patient’s primary in-center facility?

        1. AV Fistula
        2. Graft with AV Fistula
        3. Graft without AV Fistula
        4. Catheter
        5. Port Access
        6. Unknown
      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        Data are from the Centers for Medicare and Medicaid Services (CMS) End Stage Renal Disease (ESRD) Clinical Performance Measures (CPM) project. Included patients are those whose date of dialysis initiation, according to the CPM data, occurs in the same year as the data collection, and access type represents the access used during the last quarter of the year, according to the CPM data. CPM is a CMS project developed to collect information on the quality of care provided to the ESRD dialysis patient. The data originate from surveys completed by the patients’ primary care facilities, which have been collected on a yearly basis, resulting in a rich source of detailed information useful in the analysis of health care delivery to the dialysis patient. The measure was added to monitor the recommendation that catheter use as the only access mode be reduced.

      Changes Between HP2010 and HP2020: 
      This objective differs from Healthy People 2010 objective 4-4, which tracked the use of arteriovenous fistulas as the primary mode of vascular access by new hemodialysis patients aged 20 years and over. This objective tracks the proportion of all hemodialysis patients aged 18 years and over who use catheters as the only mode of vascular access.

      References

      Additional resources about the objective

      1. More details on the methods used for calculating rates can be found in Appendix A of the USRDS Annual Data Report Atlas.

    • CKD-11.3 Increase the proportion of adult hemodialysis patients who use arteriovenous fistulas or have a maturing fistula as the primary mode of vascular access at the start of renal replacement therapy

      About the Data: National

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Clinical Performance Measures Project
      United States Renal Data System
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      31.6 (2007)
      Target: 
      34.8
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of new hemodialysis patients with a Medical Evidence Form (CMS-2728) aged 18 years and over indicating use of an AV fistula or maturing fistula as the primary mode of vascular access

      Denominator: 

      Number of new hemodialysis patients with a completed Medical Evidence Form (CMS-2728), aged 18 years and over

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From CMS Medical Evidence Form 2728:

        [NUMERATOR:]

        What access was used on first outpatient dialysis?

        1. AV Fistula
        2. Graft
        3. Catheter
        4. Other
        5. Unknown

        If not AVF, then is maturing AVF present?

        1. Yes
        2. No
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        The United States Renal Data System (USRDS) uses data collected by the Centers for Medicare and Medicaid Services. Since 1996, Health Care providers have been required to provide patient information on all persons with end-stage renal disease (ESRD), regardless of health insurance. Therefore, incident rates reflect the universe of ESRD cases in the United States. The cohorts include new hemodialysis patients, limited to those age 18 and older at initiation and with a known vascular access at that time.

      Changes Between HP2010 and HP2020: 
      This objective differs from Healthy People 2010 objective 4-4, which tracked the use of arteriovenous fistulas as the primary mode of vascular access by new hemodialysis patients aged 20 years and over. This objective tracks the use of arteriovenous fistulas or maturing fistulas as the primary mode of vascular access by new hemodialysis patients aged 18 years and over.

      About the Data: State

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the state-level data.

      Data Source: 
      Clinical Performance Measures Project
      United States Renal Data System
      Measure: 
      percent
      Numerator: 

      Number of new hemodialysis patients with a Medical Evidence Form (CMS-2728) aged 18 years and over indicating use of an AV fistula or maturing fistula as the primary mode of vascular access

      Denominator: 

      Number of new hemodialysis patients with a completed Medical Evidence Form (CMS-2728), aged 18 years and over

      Questions Used to Obtain the State Data: 

          From CMS Medical Evidence Form 2728:

          [NUMERATOR:]

          What access was used on first outpatient dialysis?

          1. AV Fistula
          2. Graft
          3. Catheter
          4. Other
          5. Unknown

          If not AVF, then is maturing AVF present?

          1. Yes
          2. No
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

          The United States Renal Data System (USRDS) uses data collected by the Centers for Medicare and Medicaid Services. Since 1996, Health Care providers have been required to provide patient information on all persons with end-stage renal disease (ESRD), regardless of health insurance. Therefore, incident rates reflect the universe of ESRD cases in the United States. The cohorts include new hemodialysis patients, limited to those age 18 and older at initiation and with a known vascular access at that time.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2018, the original baseline was revised from 31.3 to 31.6 percent due to USRDS rates re-estimation. There is some lag in reporting new cases of ESRD. Therefore, each year’s Annual Data Report includes re-estimates of earlier year rates. For more information see the USRDS Annual Data Reports. The target was adjusted from 34.4 to 34.8 percent to reflect the revised baseline using the original target-setting method.

      References

      Additional resources about the objective

      1. More information on the analytic methods used to calculate these rates can be found in Appendix A of the USRDS Annual Data Report Atlas

      2. U.S. Renal Data System, USRDS 2012 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, 2012
  • CKD-12 Increase the proportion of dialysis patients waitlisted and/or receiving a deceased donor kidney transplant within 1 year of end-stage renal disease (ESRD) start (among patients under 70 years of age)

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    United States Renal Data System
    Changed Since the Healthy People 2020 Launch: 
    Yes
    Measure: 
    percent
    Baseline (Year): 
    16.9 (2006)
    Target: 
    18.6
    Target-Setting Method: 
    10 percent improvement
    Numerator: 

    Number of persons under age 70 years registered on the kidney transplant waiting list or receiving a deceased donor kidney within one year of initiation of renal replacement therapy.

    Denominator: 

    Number of incident persons on renal replacement therapy under age 70 years in a year; does not include living donor kidney transplant recipients.

    Comparable Healthy People 2010 Objective: 
    Adapted from HP2010 objective
    Data Collection Frequency: 
    Annual
    Methodology Notes: 

      Data on the number of persons on transplant waiting lists include data from the Organ Procurement and Transplant Network (OPTN) and the United Network for Organ Sharing (UNOS).

      The cohort here includes patients younger than 70 in 1991–2009. Percentages are calculated as the number of patients placed on the deceased donor organ wait list or receiving a deceased donor transplant within one year of initiation, divided by the number of patients without a living donor available (i.e., patients receiving a living donor transplant are excluded), and are estimated using the Kaplan-Meier method.

    Changes Between HP2010 and HP2020: 
    This objective differs from Healthy People 2010 objective 04-05, which tracked the proportion of dialysis patients under age 70 years, who were registered on the kidney waiting list within one year of the onset of ESRD. This objective tracks those persons as well as tracks persons under age 70 years who received a deceased donor kidney within one year of the initiation of renal replacement therapy.

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch: 
    In 2017, the original baseline was revised from 17.1 to 16.9 percent due to USRDS rates re-estimation. There is some lag in reporting new cases of ESRD. Therefore, each year’s Annual Data Report includes re-estimates of earlier year rates. For more information see the USRDS Annual Data Reports. The target was adjusted from 18.8 to 18.6 percent to reflect the revised baseline using the original target-setting method.

    References

    Additional resources about the objective

    1. The USRDS data, data collection procedures, calculation methods, and other technical information can be found in Appendix A of the Annual Data Report Atlas.

    2. U.S. Renal Data System, USRDS 2012 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, 2012
  • CKD-13 Increase the proportion of patients with treated chronic kidney failure who receive a transplant

    • CKD-13.1 Increase the proportion of patients receiving a kidney transplant within 3 years of end-stage renal disease (ESRD)

      About the Data: National

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      United States Renal Data System
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      18.3 (2004)
      Target: 
      20.1
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of persons under age 70 years receiving a kidney transplant within three years of initiation of renal replacement therapy.

      Denominator: 

      Number of incident persons on renal replacement therapy under age 70 years.

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        Data on the number of persons on transplant waiting lists include data from the Organ Procurement and Transplant Network (OPTN) and the United Network for Organ Sharing (UNOS). Data include patients from 1991–2007 who are younger than 70 at ESRD certification. Patients are followed for three years, from ESRD certification until the first of death, transplant, or censoring at three years post-transplant. Percentages are calculated using the Kaplan-Meier methodology.

      About the Data: State

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the state-level data.

      Data Source: 
      United States Renal Data System
      Measure: 
      percent
      Numerator: 

      Number of persons under age 70 years receiving a kidney transplant within three years of initiation of renal replacement therapy.

      Denominator: 

      Number of incident persons on renal replacement therapy under age 70 years.

      Data Collection Frequency: 
      Annual
      Methodology Notes: 

          Data on the number of persons on transplant waiting lists include data from the Organ Procurement and Transplant Network (OPTN) and the United Network for Organ Sharing (UNOS). Data include patients from 1991–2007 who are younger than 70 at ESRD certification. Patients are followed for three years, from ESRD certification until the first of death, transplant, or censoring at three years post-transplant. Percentages are calculated using the Kaplan-Meier methodology.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2015, the original baseline was revised from 17.9 to 18.3 percent due to USRDS rates re-estimation. There is some lag in reporting new cases of ESRD. Therefore, each year’s Annual Data Report includes re-estimates of earlier year rates. For more information see the USRDS Annual Data Reports. The target was adjusted from 19.7 to 20.1 percent to reflect the revised baseline using the original target-setting method.

      References

      Additional resources about the objective

      1. The USRDS data, data collection procedures, calculation methods, and other technical information can be found in Appendix A of the Annual Data Report Atlas.

    • CKD-13.2 Increase the proportion of patients who receive a preemptive transplant at the start of ESRD

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      United States Renal Data System
      Changed Since the Healthy People 2020 Launch: 
      No
      Measure: 
      percent
      Baseline (Year): 
      4.0 (2007)
      Target: 
      Not applicable
      Target-Setting Method: 
      This measure is being tracked for informational purposes. If warranted, a target will be set during the decade.
      Target-Setting Method Justification: 
      The baseline of the proportion of end-stage renal disease patients (ESRD) under 70 years of age who received a preemptive transplant at the start of ESRD in 2007 was 3.4 percent. In 2008 and 2009, this proportion decreased to 3.3 percent and 3.2 percent, respectively. Because of the uncertainty about whether the supply of kidneys will increase substantially, setting a target is difficult. The measure will be tracked over the decade, and a target may be added if changes in the rate of kidney donation warrant.
      Numerator: 

      Number of persons under age 70 years with kidney transplant as first treatment modality.

      Denominator: 

      Number of incident persons on renal replacement therapy, under age 70 years.

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        The cohort includes patients from 1992–2010 who are younger than 70 at the initiation of end-stage renal disease (ESRD). Pre-emptive transplants are those in which ESRD initiation date is the date of transplant.

        Percentages are calculated in the usual way: 100 X (N/D), where N is the number of preemptive transplants in the year and D is the number of ESRD patients in the year.

        The United States Renal Data System (USRDS) data, data collection procedures, calculation methods, and other technical information can be found in Appendix A of the Annual Data Report Atlas.

      Changes Between HP2010 and HP2020: 
      This objective differs from Healthy People 2010 objective 04-06, which tracked the number of persons under age 70 who received a kidney transplant within 3 years of initiation of ESRD. This objective tracks the number of persons under age 70 who receive a preemptive transplant at the start of ESRD.

      References

      Additional resources about the objective

      1. More information can be found in Appendix A of the USRDS Annual Data Report Atlas.

  • CKD-14 Reduce deaths in persons with end-stage renal disease (ESRD)

    • CKD-14.1 Reduce the total number of deaths for persons on dialysis

      About the Data: National

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      United States Renal Data System
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      per 1,000 patients years at risk
      Baseline (Year): 
      208.1 (2007)
      Target: 
      187.4
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Deaths among persons on dialysis

      Denominator: 

      Period prevalent dialysis population

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        This measure is translated into patient years at risk (instead of a rate per population) in order to obtain a more uniform rate to track over time. Cohorts for these tables include period prevalent dialysis patients in each calendar year, 2000–2010, whose first end-stage renal disease (ESRD) service date is at least 90 days prior to the beginning of the year (point prevalent patients on January 1) or who reach day 91 of ESRD treatment during the year (incident patients).

        Patients with unknown age, gender, or race, and those with an age calculated to be less than zero are excluded, as are patients who are not residents of the 50 states, the District of Columbia, Puerto Rico, or the Territories.

        Age is calculated on January 1. Race is defined from the ESRD Medical Evidence form. Cardiovascular mortality is defined using codes from past and current ESRD Death Notification Form CMS-2746-U3: 01, 02, 03, 04, 23, 25, 26, 27, 28, 29, 30, 31, 32, 36, and 37.

        Patients are followed from January 1 (for point prevalent dialysis patients) or day 91 of ESRD (for incident dialysis patients) until death, transplant, or December 31 of the year. Rates are estimated as the number of patients who die from any cause in each year, per 1,000 patient years at risk.

      About the Data: State

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the state-level data.

      Data Source: 
      United States Renal Data System
      Measure: 
      per 1,000 patients years at risk
      Numerator: 

      Deaths among persons on dialysis

      Denominator: 

      Period prevalent dialysis population

      Data Collection Frequency: 
      Annual
      Methodology Notes: 

          This measure is translated into patient years at risk (instead of a rate per population) in order to obtain a more uniform rate to track over time. Cohorts for these tables include period prevalent dialysis patients in each calendar year, 2000–2010, whose first end-stage renal disease (ESRD) service date is at least 90 days prior to the beginning of the year (point prevalent patients on January 1) or who reach day 91 of ESRD treatment during the year (incident patients).

          Patients with unknown age, gender, or race, and those with an age calculated to be less than zero are excluded, as are patients who are not residents of the 50 states, the District of Columbia, Puerto Rico, or the Territories.

          Age is calculated on January 1. Race is defined from the ESRD Medical Evidence form. Cardiovascular mortality is defined using codes from past and current ESRD Death Notification Form CMS-2746-U3: 01, 02, 03, 04, 23, 25, 26, 27, 28, 29, 30, 31, 32, 36, and 37.

          Patients are followed from January 1 (for point prevalent dialysis patients) or day 91 of ESRD (for incident dialysis patients) until death, transplant, or December 31 of the year. Rates are estimated as the number of patients who die from any cause in each year, per 1,000 patient years at risk.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2018, the original baseline was revised from 212.0 to 208.2 deaths per 1,000 patients years at risk due to USRDS rates re-estimation. There is some lag in reporting new cases of ESRD. Therefore, each year’s Annual Data Report includes re-estimates of earlier year rates. For more information see the USRDS Annual Data Reports. The target was adjusted from 190.8 to 187.4 deaths per 1,000 patients years at risk to reflect the revised baseline using the original target-setting method.

      References

      Additional resources about the objective

      1. More information on the analytic methods used to calculate these rates can be found in Appendix A of the USRDS Annual Data Report Atlas

      2. U.S. Renal Data System, USRDS 2012 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, 2012
    • CKD-14.2 Reduce the number of deaths in dialysis patients within the first 3 months of initiation of renal replacement therapy

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      United States Renal Data System
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      per 1,000 patients years at risk
      Baseline (Year): 
      372.2 (2007)
      Target: 
      335.0
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Deaths among persons in the first 3 months of dialysis

      Denominator: 

      Incident dialysis population

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        This measure is translated into patient years at risk (instead of a rate per population) in order to obtain a more uniform rate to track over time. Cohorts here include incident dialysis patients in each calendar year, 2000–2010.

        Patients with recovered kidney function are excluded. Patients with unknown age, gender, or race, and those with an age calculated to be less than zero are also excluded, as are patients who are not residents of the 50 states, the District of Columbia, Puerto Rico, or the Territories.

        Age is calculated as of the first end-stage renal disease (ESRD) service date. Patients are followed from the first service date until death, transplant, or 90 days after ESRD. Rates are estimated as the number of patients who die from any cause per 1,000 patient years at risk.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2018, the original baseline was revised from 355.5 to 372.2 deaths per 1,000 patients years at risk due to USRDS rates re-estimation. There is some lag in reporting new cases of ESRD. Therefore, each year’s Annual Data Report includes re-estimates of earlier year rates. For more information see the USRDS Annual Data Reports. The target was adjusted from 319.9 to 335.0 deaths per 1,000 patients years at risk to reflect the revised baseline using the original target-setting method.

      References

      Additional resources about the objective

      1. More information on the analytic methods used to calculate these rates can be found in Appendix A of the USRDS Annual Data Report Atlas

      2. U.S. Renal Data System, USRDS 2012 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, 2012
    • CKD-14.3 Reduce the number of cardiovascular deaths for persons on dialysis

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      United States Renal Data System
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      per 1,000 patients years at risk
      Baseline (Year): 
      90.3 (2007)
      Target: 
      81.3
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Cardiovascular deaths among persons on dialysis.

      Denominator: 

      Period prevalent dialysis population.

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        This measure is translated into patient years at risk (instead of a rate per population) in order to obtain a more uniform rate to track over time. Cohorts for these tables include period prevalent dialysis patients in each calendar year, 2000–2010, whose first end-stage renal disease (ESRD) service date is at least 90 days prior to the beginning of the year (point prevalent patients on January 1) or who reach day 91 of ESRD treatment during the year (incident patients).

        Patients with unknown age, gender, or race, and those with an age calculated to be less than zero are excluded, as are patients who are not residents of the 50 states, the District of Columbia, Puerto Rico, or the Territories.

        Age is calculated on January 1. Race is defined from the ESRD Medical Evidence form. Cardiovascular mortality is defined using codes from past and current ESRD Death Notification Form CMS-2746-U3: 01, 02, 03, 04, 23, 25, 26, 27, 28, 29, 30, 31, 32, 36, and 37.

        Patients are followed from January 1 (for point prevalent dialysis patients) or day 91 of ESRD (for incident dialysis patients) until death, transplant, or December 31 of the year. Rates are estimated as the number of patients who die from cardiovascular disease in each year, per 1,000 patient years at risk.

      Changes Between HP2010 and HP2020: 
      This objective differs from Healthy People 2010 objective 14.3, in that the denominator for the Healthy People 2010 objective was the number of persons with ESRD, while the denominator for this objective is the period prevalent dialysis population.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2018, the original baseline was revised from 90.4 to 90.3 deaths per 1,000 patients years at risk due to USRDS rates re-estimation. There is some lag in reporting new cases of ESRD. Therefore, each year’s Annual Data Report includes re-estimates of earlier year rates. For more information see the USRDS Annual Data Reports. The target was adjusted from 81.4 to 81.3 deaths per 1,000 patients years at risk to reflect the revised baseline using the original target-setting method.

      References

      Additional resources about the objective

      1. More information on the analytic methods used to calculate these rates can be found in Appendix A of the USRDS Annual Data Report Atlas.

      2. U.S. Renal Data System, USRDS 2012 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, 2012
    • CKD-14.4 Reduce the total number of deaths for persons with a functioning kidney transplant

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      United States Renal Data System
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      per 1,000 patients years at risk
      Baseline (Year): 
      30.8 (2007)
      Target: 
      27.8
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Deaths among persons with a functioning kidney transplant.

      Denominator: 

      Period prevalent kidney transplant population.

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        This measure is translated into patient years at risk (instead of a rate per population) in order to obtain a more uniform rate to track over time. Cohorts for these tables include period prevalent transplant patients in each calendar year, 2000–2010, whose first ESRD service date is at least 90 days prior to the beginning of the year (point prevalent patients on January 1) or who reach day 91 of ESRD treatment during the year (incident patients).

        Patients with unknown age, gender, or race, and those with an age calculated to be less than zero are excluded, as are patients who are not residents of the 50 states, the District of Columbia, Puerto Rico, or the Territories.

        Patients are followed from January 1 (for point prevalent dialysis patients) or day 91 of ESRD (for incident dialysis patients) until death, transplant, or December 31 of the year. Rates are estimated as the number of patients who die from any cause in each year, per 1,000 patient years at risk.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2018, the original baseline was revised from 32.6 to 30.9 deaths per 1,000 patients years at risk due to USRDS rates re-estimation. There is some lag in reporting new cases of ESRD. Therefore, each year’s Annual Data Report includes re-estimates of earlier year rates. For more information see the USRDS Annual Data Reports. The target was adjusted from 29.4 to 27.8 deaths per 1,000 patients years at risk to reflect the revised baseline using the original target-setting method.

      References

      Additional resources about the objective

      1. More information on the analytic methods used to calculate these rates can be found in Appendix A of the USRDS Annual Data Report Atlas.

      2. U.S. Renal Data System, USRDS 2012 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, 2012
    • CKD-14.5 Reduce the number of cardiovascular deaths in persons with a functioning kidney transplant

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      United States Renal Data System
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      per 1,000 patients years at risk
      Baseline (Year): 
      5.0 (2007)
      Target: 
      3.0
      Target-Setting Method: 
      2 percentage point improvement
      Target-Setting Method Justification: 
      In 2007, the cardiovascular death rate in persons with functioning kidney transplants was 6.5 per 1,000 patient years at risk. Clinically, a 2-percentage point reduction is meaningful and achievable.
      Numerator: 

      Cardiovascular deaths among persons with a functioning kidney transplant.

      Denominator: 

      Period prevalent kidney transplant population.

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Methodology Notes: 

        This measure is translated into patient years at risk (instead of a rate per population) in order to obtain a more uniform rate to track over time. Cohorts for these tables include period prevalent transplant patients in each calendar year, 2000–2010, whose first end-stage renal disease (ESRD) service date is at least 90 days prior to the beginning of the year (point prevalent patients on January 1) or who reach day 91 of ESRD treatment during the year (incident patients).

        Patients with unknown age, gender, or race, and those with an age calculated to be less than zero are excluded, as are patients who are not residents of the 50 states, the District of Columbia, Puerto Rico, or the Territories.

        Patients are followed from January 1 (for point prevalent dialysis patients) or day 91 of ESRD (for incident dialysis patients) until death, transplant, or December 31 of the year. Rates are estimated as the number of patients who die from cardiovascular disease in each year, per 1,000 patient years at risk.

      Changes Between HP2010 and HP2020: 
      This objective differs from Healthy People 2010 objective 04-02, which tracked cardiovascular deaths among persons with ESRD. This objective tracks cardiovascular deaths among persons with a functioning kidney transplant.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2018, the original baseline was revised from 6.5 to 5.0 deaths per 1,000 patients years at risk due to USRDS rates re-estimation. There is some lag in reporting new cases of ESRD. Therefore, each year’s Annual Data Report includes re-estimates of earlier year rates. For more information see the USRDS Annual Data Reports. The target was adjusted from 4.5 to 3.0 deaths per 1,000 patients years at risk to reflect the revised baseline using the original target-setting method.

      References

      Additional resources about the objective

      1. More information on the analytic methods used to calculate these rates can be found in Appendix A of the USRDS Annual Data Report Atlas.