CKD Patient

Definition

Patients with chronic kidney disease (CKD). CKD patients are identified using the CMS CCW definition, which is based on ICD-10-CM codes found in medical claim diagnoses, or by an administrative designation of the patient as an ESRD beneficiary in the CMS Monthly Membership Report. The patient’s CKD status can change over time, so a patient timeline data structure is appropriate.

Purpose

Used in the URSA-CKD module to define the starting population for most of the module’s objects and analytics.

Related Objects

• Patient Timelines for CCW Conditions
• Patient Timelines of Any Plan Membership
• Patient Timelines for CKD Stage
• Patient Timelines Master for URSA-CKD Concepts

Detailed Narrative of Logic

1. Both Patient Timelines for CKD Stage and Patient Timelines Master for URSA-CKD Concepts effectively implement the same relatively simple definition of CKD, described below.
2. Patients meeting the CCW definition of CKD are considered to be CKD patients. Details of the CCW logic can be found here: https://www2.ccwdata.org/web/guest/condition-categories-chronic; in particular, see value set CCW CKD, implemented in Patient Timelines for CCW Conditions. 
3. Additionally, patients identified as ESRD beneficiaries in the CMS Monthly Membership report (or other source data table passing along information originally received via the MMR) are considered to be CKD patients. That information is obtained from Patient Timelines of Any Plan Membership, which synthesizes information from all of a patient’s active memberships.
4. Both criteria reflect dynamic characteristics of the patient that might change over time and so are captured in timeline objects — i.e., Patient Timelines for CKD Stage and Patient Timelines Master for URSA-CKD Concepts — reflecting that full, longitudinal picture of the patient.