Chronic Kidney Disease (CKD) is a major driver of morbidity, mortality, and high healthcare costs in the United States. It increases risk of heart disease, stroke, and death. Currently, 36 million American adults have CKD and millions of others are at increased risk. 90% of those with CKD are unaware of their condition because it often has no symptoms until later stages.
Diabetes, the most prevalent risk factor for CKD, is a major driving force behind this significant public health concern. Regular evaluations, early detection, and timely interventions make a significant difference in lowering the cost of CKD and improving patient outcomes.
KED as a Quality Measure
In 2020, the NCQA and National Kidney Foundation (NKF) introduced Kidney Health Evaluation for Patients with Diabetes (KED) to assess kidney function for this high-risk population and facilitate early diagnosis of CKD. KED replaces the previous quality measure known as Comprehensive Diabetes Care-Kidney Disease Monitoring/Medical Attention for Nephropathy, and measure definitions for each differ.
KED, a HEDIS quality measure, assesses whether individuals 18-85 years old with diabetes (type 1 or type 2) receive a kidney health evaluation, which includes two tests during the measurement year — a blood test and a urine test:
- An Estimated Glomerular Filtration Rate (eGFR)
- A Urine Albumin-Creatinine Ratio (uACR)
- Both a quantitative urine albumin lab test and a urine creatinine test with service dates 4 days apart or less
- OR
- Urine Albumin-Creatinine Ratio Lab Test
Both tests are important. The eGFR assesses kidney function, while the uACR assesses damages and serves as an early indicator of kidney disease. Clinical guidelines from the American Diabetes Association (ADA) and the NKF recommend screening each year. Exclusions from quality reporting for this measure include end stage renal disease or dialysis, hospice or palliative care, advanced illness and frailty criteria, enrolled in an Institutional Special Needs Plan, or living long-term in an institution.
KED Quality Measure Best Practices & Tips
- Educate patients about the effects of diabetes on kidneys and the importance of annual testing
- Emphasize the importance of medication adherence
- Consult with Pharmacy team members to support medication management
- Create automatic flags in the EHR to alert staff when patients are due for screenings
- Use standing orders to facilitate pre-visit planning where appropriate
- Order and complete labs prior to patient appointments so results will be available during the office visit
- Utilize Care Coordination teams for patient outreach
- Send regular patient reminders for due or overdue evaluations
- Coordinate diabetes care with specialists as needed
- Utilize appropriate coding and documentation to reflect care provided
Diabetes is the leading cause of CKD. Kidney Health Evaluation for Patients with Diabetes (KED) quality measure provides a way to monitor and improve rates of evaluation, enabling earlier detection and intervention for this high-risk population.
RESOURCES: NCQA Kidney Health Toolkit, Kidney.org, eCQI KED , NCQA KED
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