End Stage Renal Disease  

Access the Final Report: National Voluntary Consensus Standards for End Stage Renal Disease (ESRD) 2010: A Consensus Report 

Measures focused only on chronic kidney disease will not be accepted for consideration in this project. NQF will consider measures that address chronic kidney disease as it relates to ESRD, such as effective transitioning to renal replacement therapy.

NOTE: All remaining NQF-endorsed® ESRD standards, as well as new renal measures, will be reviewed in an upcoming endorsement maintenance cycle project for renal disease.  

The Opportunity

Over half a million American lives have been altered by a diagnosis of End Stage Renal Disease (ESRD), a serious condition that is almost always fatal unless treated with dialysis or transplantation. ESRD is the only disease-specific condition that is explicitly guaranteed Medicare coverage, with Medicare costs for the condition reaching $23.9 billion in 2007. In the same year, all-cause mortality rates for ESRD were roughly 6–8 times higher for dialysis patients than for the general population.  ¹  

In 2007, incident rates of ESRD fell 2.1% to 354 per million population (over 527,000 cases) — the first decline in rates since 1995. Racial and ethnic differences persist, with 2007 rates in the African American and Native American populations 3.7 and 1.8 times greater, respectively, than the rate among Caucasians, and the rate in the Hispanic population 1.5 times higher than that of non-Hispanics.  ²  

In 2008, NQF endorsed 25 measures for ESRD care in the areas of anemia; dialysis adequacy; mineral metabolism; vascular access; influenza immunization; mortality; and patient education, perception of care, and quality of life. These measures were intended to facilitate efforts to improve the quality of care delivered to ESRD patients in all care settings, including dialysis facilities, in-home settings, physician offices, and hospitals.

The current project is limited to consideration of additional quality performance measures for patients with ESRD. However, measures that address chronic kidney disease (CKD) to a limited extent, such as those focused on transitioning to successful renal replacement therapy from stage 4 CKD or measures for which the evidence indicates applicability for both ESRD and CKD will be considered for endorsement.

The current project scope does not encompass comprehensive care for CKD which will be addressed in an upcoming endorsement maintenance cycle project for renal disease. Measure developers with renal measures outside the scope of this project (e.g. chronic kidney disease measures) may notify NQF via the “readiness to submit” form.

Although glycemic control and hypertension management may delay progression of kidney failure or cardiovascular complications, NQF-endorsed standards on those topics should be used for ESRD and CKD unless there is evidence supporting specific differences. Review of NQF-endorsed® standards relating to ESRD and/or CKD for maintenance of endorsement will only be conducted in this project if similar candidate standards are submitted that could potentially replace or expand the endorsed standard (e.g., relevant to pediatric patients in addition to adults). NOTE: All remaining NQF-endorsed® ESRD standards, as well as new renal measures, will be reviewed in an upcoming endorsement maintenance cycle project for renal disease.

About the Project

This project began in August 2010.

Objectives 

NQF seeks to identify and endorse additional measures addressing quality of care for ESRD for public reporting and quality improvement. Measures also may address effective transitioning to renal replacement therapy. To the extent that the evidence indicates a measure focus also is applicable to CKD, it should be included in the target population (denominator). Measures focused only on CKD will not be accepted for consideration in this project.

NQF Process 

Measures will be considered for NQF endorsement as national voluntary consensus standards. Consensus on the recommendations developed through NQF’s formal Consensus Development Process (CDP, Version 1.8). This project involves the active participation of representatives from across the spectrum of healthcare stakeholders and will be guided by a Steering Committee.

Funding 

This project is supported under a contract provided by the Centers for Medicare & Medicaid Services.

Related NQF Work 

National Voluntary Consensus Standards for End Stage Renal Disease Care: A Consensus Report 

Contact Information 

For further information, contact Katie Streeter at 202-783-1300 or via e-mail at esrd@qualityforum.org.

Notes 
1. U.S. Renal Data System, USRDS 2009 Annual Data Report: Atlas of End-Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2009.
Available at http://www.usrds.org/atlas.htm Last accessed on July 6, 2010.
2. Vassalotti, JA, Stevens, LA, Levey, AS, Testing for Chronic Kidney Disease: A Position Statement From the National Kidney Foundation, American Journal of Kidney Disease, 2007; 50(2):169-344, p.A1-A48.