Highlights Among Medicare beneficiaries aged >= 65 years, the percentage receiving a follow-up kidney evaluation in the 6 months after a hospitalization with acute kidney injury (AKI) (CKD-3; target 12.3%) steadily increased from 12.8% in 2009 to 18.3% in 2018, a relative improvement of >40%. All race and ethnic groups, both sexes, and all age groups experienced sizable relative percentage increases over the decade. Among Medicare beneficiaries aged >= 65 years, the percentage of persons with CKD who received medical evaluation with serum creatinine, lipid, and microalbuminuria tests increased steadily, from 29.2% in 2009 to 36.7% in 2018 (a relative increase of >25%) (CKD 4.1, target 28.4%). All race and ethnic groups, both sexes, and all age groups experienced an increase. The percentage of persons with CKD and diabetes mellitus who underwent comprehensive evaluation with serum creatinine, lipid, microalbuminuria, and hemoglobin (Hb) A1C tests and eye examinations increased by >25%, in relative terms, to 32.0% between 2009 and 2018, handily exceeding the overall target of 25.3% (CKD-4.2). While the rate of new cases of ESRD per million population (pmp) declined nearly 8% between 2009 (412.6 pmp) and 2018 (380.2 pmp), the target (352.1 pmp) was not met (CKD-8). Further, there was no significant decline between 2017 and 2018. While there was a modest decline in the rate of ESRD due to diabetes between 2009 (180.5 pmp) and 2018 (177.9 pmp), the rate varied substantially over this period, and the target rate of 154.4 pmp was not met (CKD-9.1). American Indians or Alaskan Natives and Blacks or African Americans had relative declines of 27.9% and 22.3%, respectively, but rates were relatively unchanged overall in Asians and in Native Hawaiians or other Pacific Islanders; the rate increased by 8.9% in Whites. While there was a steady increase between 2009 (28.4%) and 2018 (38.1%) in the percentage of individuals with nephrology care within one year of ESRD (CKD-10; target 30.0%), the rate nevertheless remained low overall. Thirteen states exceeded 50%, led by New Hampshire (61.1%), Hawaii (61.3%), Maine (63.1%), and Vermont (72.2%). The goal for the proportion of adult patients receiving hemodialysis who used an arteriovenous fistula (AVF) or who had a maturing fistula as the primary mode of vascular access at the start of renal replacement therapy (RRT) is 34.8% (CKD-11.3). Unfortunately, there was little net change between 2009 (32.2%) and 2018 (31.8%); the percentage peaked at 37.2% in 2013 but then steadily decreased. Across age groups, only about one in five patients aged 18-24 years used an AVF or had a maturing AVF, in contrast to about one in three patients aged 45-64 years. The target for increasing the proportion of patients who receive a kidney transplant within 3 years of ESRD is 20.1% (CKD-13.1). As of 2015, the Objective was not close to being met, with only 12.5% of patients receiving a transplant within 3 years. This represents a decrease from a high of 16.8% in 2006. There was a >5-fold difference in percentages between Hawaii (4.4%) and Minnesota (23.0%). The target rate for deaths in patients receiving dialysis, 187.3 per 1,000 patient years (py), was reached in 2010 (CKD-14.1). The rate decreased from 194.2 per 1000 py in 2009 to 170.6 in 2018, representing a relative decrease of 12.2%. However, nearly all of the decrease occurred between 2009 and 2013; after 2013, the rate remained around 170 per 1000 py. The target rate for deaths in patients receiving dialysis within the first 3 months of initiation of RRT is 335.0 deaths per 1,000 py at risk (CKD-14.2). There was a relatively steady and prolonged decline in this death rate between 2009, when the rate was 359.7 per 1000 py, and 2018, when the rate reached 261.7 (a 27.2% decrease in relative terms). With the exception of persons of two or more races (where the number of individuals is small and estimates therefore unstable), all race groups experienced a decline. The target for the reduction in the total number of deaths for persons with a functioning kidney transplant (CKD-14.4) is 27.8 per 1000 py. As of 2018, this target was not met; the rate increased from 2009 (30.8 per 1000 py) to 2017 (33.5) before falling slightly in 2018 (33.0). In 2018, the rate was over twice as high in American Indians or Alaskan Natives (47.4 per 1000 py) as in Asians (23.5); rates were slightly higher in Whites (34.1) than in Blacks or African Americans (31.9), with Native Hawaiians and Pacific Islanders in between (33.5).
