Increase the proportion of adults with diabetes and chronic kidney disease who get ACE inhibitors or ARBs — CKD‑05 Data Methodology and Measurement

About the National Data

Data

Baseline: 43.0 percent of adults aged 18 years and over with diagnosed diabetes and chronic kidney disease received recommended medical treatment with ACE inhibitors or ARBs in 2013-16

Target: 55.4 percent

Numerator
Number of adults aged 18 years and over with diagnosed diabetes and chronic kidney disease stages 1–4 who have at least one prescription for an ACE inhibitor or an ARB.
Denominator
Number of adults aged 18 years and over with diagnosed diabetes and chronic kidney disease stages 1–4.
Target-setting method

Minimal statistical significance

Target-setting method details
Minimal statistical significance, assuming the same standard error for the target as for the baseline.
Target-setting method justification
Trend data were not available for this objective. The standard error was used to calculate a target based on minimal statistical significance, assuming the same standard error for the target as for the baseline. This method was used because the target is a statistically significant improvement from the baseline. Patient care guidelines from the National Kidney Foundation and the American Diabetes Association and national efforts such as the Million Hearts Initiative make the target realistic to achieve.

Methodology

Methodology notes

Chronic kidney disease (CKD) stages 1–4 defined as urinary albumin-to-creatinine ratio (ACR) ≥ 30 mg/g (single measurement) or eGFR between 15 and 59 ml/min/1.73 m². The eGFR was computed using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Single ACR measurement was used (all measurements in mg/g).

ACE/ARB use is obtained using the NHANES prescription drug files. Numerator and denominator are based on NHANES interview question and on NHANES Mobile Examination Center laboratory testing.

History

Comparable HP2020 objective
Modified, which includes core objectives that are continuing from Healthy People 2020 but underwent a change in measurement.
Changes between HP2020 and HP2030
This objective differs from Healthy People 2020 objective CKD-5 in that CKD-5 used data from the United States Renal Data System (USRDS) to track general Medicare patients age 65 and over diagnosed with both diabetes and chronic kidney disease (CKD), who were continuously enrolled in the Medicare inpatient/outpatient and physician/supplier program, and were also enrolled in Medicare Part D during the entire year. CKD-5 defined the use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) as at least one prescription fill from either drug class during the year. In contrast, objective CKD-2030-5 uses data from the National Health and Nutrition Examination Survey to track persons aged 18 years and over with diagnosed diabetes and CKD. Diabetes diagnosis and prescription medication use are determined using interview questions and CKD diagnosis is based on laboratory testing in the NHANES mobile examination centers.