Skip Navigation U.S. Department of Health and Human Services www.hhs.gov
Agency for Healthcare Research Quality www.ahrq.gov
Archive print banner
2006 National Healthcare Quality Report

Effectiveness of Care: End Stage Renal Disease

This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: https://info.ahrq.gov. Let us know the nature of the problem, the Web address of what you want, and your contact information.

Please go to www.ahrq.gov for current information.


Management of End Stage Renal Disease
Dialysis patients registered on the waiting list for transplantation
Patients with treated chronic kidney failure who receive a transplant within 3 years of renal failure
Hemodialysis patients with URR 65 percent or greater
Patients with hematocrit 33 or greater or hemoglobin 11 or greater
Patient survival rate
Use of arteriovenous fistulas new hemodialysis patients (age 18+)


Management of End Stage Renal Disease

Measure Title

Percent of dialysis patients registered on the waiting list for transplantation.

Measure Source

Healthy People 2010, measure 4-5.

Tables

1.29a. Percent of dialysis patients registered on the waiting list for transplantation, United States, 1999 and 2003.

1.29b. Percent of dialysis patients registered on the waiting list for transplantation, by State, 1998 and 2003.

Data Source

National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, U.S. Renal Data System (USRDS).

Denominator

All incident end stage renal disease (ESRD) Medicare patients in the given year who were under age 70 and had a known State of residence in the 50 States or DC. Patients who received a transplant at any time from a live donor were excluded from the measure.

Numerator

Subset of the denominator population who were registered on the kidney transplant waiting list on December 31 of the measure year or received a deceased-donor kidney within 1 year of their ESRD initiation date.

Comments

The measure was calculated as the percent (by Kaplan-Meier methodology) who were either wait-listed or received a deceased-donor kidney within 1 year of their ESRD initiation date.

Top of Page


Management of End Stage Renal Disease

Measure Title

Percent of patients with treated chronic kidney failure who receive a transplant within 3 years of renal failure.

Measure Source

Healthy People 2010, measure 4-6.

Tables

1.30a. Persons receiving a kidney transplant within 3 years of date of renal failure, United States, 1994-1996 and 2000.

1.30b. Persons receiving a kidney transplant within 3 years of date of renal failure, by State, 1993-1995 and 2000.

Data Source

National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, U.S. Renal Data System (USRDS).

Denominator

All Medicare dialysis patients who initiated therapy in the given year and had a known State of residence in the 50 States or DC, excluding patients with prior kidney transplants and patients over the age of 69.

Numerator

Subset of the denominator population receiving a transplant within 3 years of renal failure.

Comments

Note that the Healthy People 2010 measure refers to "with 3 years of registration on a waiting list." Measuring transplants within 3 years of renal failure yields a more complete picture of access to transplantation.

Top of Page


Management of End Stage Renal Disease

Measure Title

Percent of hemodialysis patients with URR 65 percent or greater.

National Measure Source

Centers for Medicare and Medicaid Services (CMS), End Stage Renal Disease (ESRD) Clinical Performance Measures Project.

National Table

1.31a. Percent of hemodialysis patients with urea reduction ratio 65 % or higher, United States, 2002 and 2004.

National Data Source

CMS, ESRD Clinical Performance Measures Project.

National Denominator

Medicare hemodialysis patients age 18 and over.

National Numerator

Subset of the denominator population with urea reduction ratio (URR) 65 percent or higher.

State Measure Source

University of Michigan Kidney Epidemiology and Cost Center, Unit Specific Report.

State Table

1.31b. Percent of hemodialysis patients with urea reduction ratio 65 % or higher, by State, 2000 and 2004.

State Data Source

Data from the unit-specific report for dialysis patients, University of Michigan Kidney Epidemiology and Cost Center.

State Denominator

Medicare hemodialysis patients.

State Numerator

Subset of the denominator population with urea reduction ratio (URR) 65 percent or higher.

Top of Page


Management of End Stage Renal Disease

Measure Title

Percent of patients with hematocrit 33 or greater or hemoglobin 11 or greater.

National Measure Source

Centers for Medicare and Medicaid Services (CMS), End Stage Renal Disease (ESRD) Clinical Performance Measures Project.

National Table

1.32a. Percent of hemodialysis patients with hemoglobin 11 gm/dL or higher, United States, 2002 and 2004.

National Data Source

CMS, ESRD Clinical Performance Measures Project.

National Denominator

Medicare adult (age 18 and over) in-center hemodialysis patients or peritoneal dialysis patients, exclude patients with mean hemoglobin of 12g/dL or greater who are not prescribed epoetin at any time during the study period (hemodialysis patients: October to December, peritoneal dialysis patients: January to March).

National Numerator

Subset of the denominator population with mean hemoglobin of 11g/dL or higher during the study period.

State Measure Source

University of Michigan Kidney Epidemiology and Cost Center, Unit Specific Report.

State Table

1.32b Percent of patients with hematocrit 33 or greater, by State, 2000 and 2004.

State Data Source

Data from the unit-specific report for dialysis patients, University of Michigan Kidney Epidemiology and Cost Center.

State Denominator

Medicare dialysis patients treated with erythropoietin.

State Numerator

Subset of the denominator population with hematocrit 33 or greater.

Comments

Previously, the percent of patients in the state with hematocrit of 33% or greater included all patients, but for the 2004 measure, it includes only the erythropoietin treated patients. Therefore, 2004 rates may not be comparable with earlier years.

Top of Page


Management of End Stage Renal Disease

Measure Title

Patient survival rate.

Measure Source

University of Michigan Kidney Epidemiology and Cost Center, Unit Specific Report.

Table

1.33. Standardized mortality ratio for dialysis patients, by State, 2000 and 2004.

Data Source

The University of Michigan Kidney Epidemiology and Cost Center.

Denominator

Medicare dialysis patients.

Numerator

Standardized mortality among the denominator population.

Comments

Standardized mortality ratios are used to compare mortality in annual incident populations over successive years of observation. The death rates are high during the first year of treatment, lower during the second and third years, and rise again after the fourth year.

Note that the Dialysis Facility Compare measure "patient survival rate" is equivalent to the University of Michigan standardized mortality ratios.

Top of Page


Management of End Stage Renal Disease

Measure Title

Use of arteriovenous fistulas—new hemodialysis patients (age 18 and over).

Measure Source

Centers for Medicare and Medicaid Services (CMS), End Stage Renal Disease (ESRD) Clinical Performance Measures Project.

Table

1.34. Percent of hemodialysis patients with arteriovenous fistula as primary mode of vascular access, United States, 2002 and 2004.

Data Source

CMS, ESRD Clinical Performance Measures Project.

Denominator

  1. Medicare incident adult in-center hemodialysis patients, aged 18 and over (defined as those patients initiating their most recent course of hemodialysis), or
  2. Prevalent adult (age 18 and over) hemodialysis patients in the sample for analysis.

Numerator

  1. For (1): The number of incident patients in the denominator who were dialyzed using an arteriovenous fistula during their last hemodialysis treatment.
  2. For (2): The number of prevalent patients in the denominator who were dialyzed using an arteriovenous fistula during their last hemodialysis treatment during the study period.

Top of Page
Return to Appendix Contents

 

The information on this page is archived and provided for reference purposes only.

 

AHRQ Advancing Excellence in Health Care