Effectiveness: End Stage Renal Disease

2010 National Healthcare Quality and Disparities Reports

The National Healthcare Quality Report (NHQR) is a comprehensive national overview of quality of health care in the United States. It is organized around four dimensions of quality of care: effectiveness, patient safety, timeliness, and patient centeredness.

Management of End Stage Renal Disease
Adult hemodialysis patients with adequate dialysis
Dialysis patients under age 70 who were registered on a waiting list for transplantation
Patients with treated chronic kidney failure who received a transplant within 3 years of date of renal failure
Ratio of observed deaths to expected deaths among Medicare hemodialysis patients
New end stage renal disease patients who initiated hemodialysis with an arteriovenous fistula
 


Management of End Stage Renal Disease

Measure Title

Adult hemodialysis patients with adequate dialysis.

Measure Source

University of Michigan Kidney Epidemiology and Cost Center (UMKECC), Dialysis Facility Reports.

National Table

3_1_1.1 Adult hemodialysis patients with adequate dialysis, United States, 2006-2009

National Data Source

UMKECC, Unit Specific Report (USR).

National Denominator

Medicare hemodialysis patients.

National Numerator

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

State Table

3_1_1.2 Adult hemodialysis patients with adequate dialysis, by State, 2000-2008

State Data Source

UMKECC, Unit Specific Report (USR).

State Denominator

Medicare hemodialysis patients.

State Numerator

Subset of the denominator with a URR of 65% or higher.

Comments

Standard errors were calculated based on sample N, not sampling unit; therefore, reported standard errors may be understated.

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Management of End Stage Renal Disease

Measure Title

Dialysis patients under age 70 who were registered on a waiting list for transplantation.

Measure Source

Healthy People 2010.

National Tables

3_1_2.1 Dialysis patients under age 70 who were registered on a waiting list for transplantation, United States, 1999-2006

3_1_2.2a-b Dialysis patients under age 70 who were registered on a waiting list for transplantation, United States, 2006, by:

  • Race.
  • Ethnicity.

National Data Source

National Institutes for Health (NIH), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), United States Renal Data System (USRDS).

National Denominator

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

National Numerator

Subset of the denominator 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.

State Table

3_1_2.3 Dialysis patients under age 70 who were registered on a waiting list for transplantation, by State, 1999-2006

State Data Source

NIH, NIDDK, USRDS.

State Denominator

Same as National.

State Numerator

Same as National.

Comments

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

This measure is referred to as measure 4-5 in Healthy People 2010 documentation.

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Management of End Stage Renal Disease

Measure Title

Patients with treated chronic kidney failure who received a transplant within 3 years of date of renal failure.

Measure Source

Healthy People 2010.

National Tables

3_1_3.1 Patients with treated chronic kidney failure who received a transplant within 3 years of date of renal failure, United States, 1998-2004

3_1_3.2a-b Patients with treated chronic kidney failure who received a transplant within 3 years of date of renal failure, United States, 2004, by:

  • Race.
  • Ethnicity.

National Data Source

National Institutes for Health (NIH), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), United States Renal Data System (USRDS).

National Denominator

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

National Numerator

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

State Table

3_1_3.3 Patients with treated chronic kidney failure who received a transplant within 3 years of date of renal failure, by State, 2000-2004

State Data Source

NIH, NIDDK, USRDS.

State Denominator

Same as National.

State Numerator

Same as National.

Comments

Note that the Healthy People 2010. measure refers to "within 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.

This measure is referred to as measure 4-6 in Healthy People 2010 documentation.

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Management of End Stage Renal Disease

Measure Title

Ratio of observed deaths to expected deaths among Medicare hemodialysis patients.

Measure Source

University of Michigan Kidney Epidemiology and Cost Center (UMKECC), Unit Specific Report (USR).

State Table

3_1_4.1 Standardized mortality ratio for dialysis patients, by State, 2000-2008

State Data Source

UMKECC, USR.

State Denominator

Medicare dialysis patients.

State Numerator

Standardized mortality among the denominator population.

Comments

Standardized mortality ratios (SMRs) 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, are lower during the second and third years, and rise again after the fourth year.

Note that the Compare measure pertinent to Dialysis Facility, "patient survival rate," is equivalent to the University of Michigan SMR.

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Management of End Stage Renal Disease

Measure Title

New end stage renal disease patients who initiated hemodialysis with an arteriovenous fistula.

Measure Source

Centers for Medicare & Medicaid Services (CMS).

National Tables

3_1_5.1 New end stage renal disease patients who initiated hemodialysis with an arteriovenous fistula, United States, 2008-2009, National Data Source CMS.

National Denominator

All incident hemodialysis patients in identified group in designated year.

National Numerator

All patients in the denominator for whom access used on first outpatient dialysis was given as "AVF."

State Tables

3_1_5.2 New end stage renal disease patients who initiated hemodialysis with an arteriovenous fistula, by State, 2008-2009

State Data Source

Centers for Medicare & Medicaid Services (CMS).

State Denominator

Same as National.

State Numerator

Same as National.

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Return to Measure Specifications

Page last reviewed February 2011
Internet Citation: Effectiveness: End Stage Renal Disease: 2010 National Healthcare Quality and Disparities Reports. February 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/nhqrdr/nhqrdr10/measurespec/end_stage_renal_disease.html