Posted Jul 6 , 2017 04:13 AM

Annual VA Spending for CKD Steadily Increasing

Monaco K, (contributing writer) MEDPAGE Today, April 24, 2017

What were the findings (excerpted from the Article)?

Rajiv Saran, MD, of the University of Michigan, and colleagues found the total cost of Chronic Kidney Disease (CKD) care in the Department of Veterans Affairs healthcare system increased from $12 billion in 2006 to $19 billion in 2014 in current dollars. Adjusted for inflation, the increase was 26%, the researchers reported as a late breaking abstract at the National Kidney Foundation's 2017 Spring Clinical Meeting.

Saran and colleagues established the VA Renal Information System (VA-REINS) by pooling individual electronic medical records from the VA Corporate Data Warehouse, as well as several other sources such as the IPEC Dialysis Dashboard, VA Medicare Linked Data, and National Centers for Medicare and Medicaid Services (CMS) ESRD data sources.  About 7 million VA patients are included in the VA-REINS system, all of whom visited a VA facility at least once during a span of three federal fiscal years and still alive during the beginning of the current fiscal year. There were 1.1 million (16%) VA users identified as having CKD through a restrictive definition, which included a persistent eGFR of less than 60 mL/min with any evidence of proteinuria, or an ICD-9 diagnosis.  Because health system recognition depends on the physicians’ testing them for kidney disease, the researchers also conducted a second analysis using a broader definition of CKD in order to "cast a wider net” to identify people who may be at risk of CKD, or may actually have CKD and may not be showing up in the healthcare system. These findings helped to prioritize CKD as an important clinical issue for the VA, Saran suggested, stating the high costs associated with CKD were previously unknown to the organization. Additionally, the newly established VA-REINS has great potential for population-based cost tracking, as well as disease management, surveillance, and prevention.

Why is this important?

A study published in 2011 found that nearly 1 in 4 patients in the VA system has diabetes. ( In a more recent article (Rand Health Q. 2016 May 9; 5:13), Eibner, et al reviewed the healthcare needs of VA patients highlighting hypertension and diabetes as significant problems, both of which contribute to kidney disease. With diabetes being the most common cause of kidney disease, it is especially important in a VA population to be cognizant of the increased risk, and aggressive in the treatment of both hypertension and diabetes! With the incidence of diabetes and hypertension outside the VA increasing as well, it is important to redouble our efforts to control both of these predisposing conditions. Do you regularly screen your patients for kidney disease?  Have you found it more often than you thought? 

Screening for kidney disease is recommended by ADA as follows:

At least once a year, assess urinary albumin (e.g., spot urinary albumin–to–creatinine ratio) and estimated glomerular filtration rate in patients with type 1 diabetes with duration of ≥5 years, in all patients with type 2 diabetes, and in all patients with comorbid hypertension (Diabetes Care 2017 Jan; 40(Supplement 1): S88-S98).

Read the Article: