Renal Endorsement Maintenance 2011 

Access the Endorsement Summary (PDF) | Access the Full Report  

The Opportunity

Renal-related diseases are a leading cause of morbidity and mortality in the United States.

An estimated 31 million adults (16 percent of the population) in the United States have chronic kidney disease (CKD). It is associated with premature mortality, decreased quality of life, and increased healthcare costs totaling 24.5 percent of overall Medicare expenditures in 2008.¹ Risk factors for CKD include cardiovascular disease, diabetes, hypertension, and obesity.

Untreated CKD can result in end stage renal disease (ESRD). Currently, over half a million people in the United States have received a diagnosis of ESRD. In 2008, costs for ESRD rose 13.2 percent to $26.8 billion. It is the only disease-specific condition that is explicitly guaranteed Medicare coverage. Additionally, racial and ethnic differences continue to persist. In 2007, rates in the African American and Native American populations were 3.7 and 1.8 times greater, respectively, than the rate among Caucasians. Additionally, the rate of ESRD in the Hispanic population was 1.5 times higher than that of non-Hispanics. ² Adjusted rates of all-cause mortality rates are roughly six to eight times higher for dialysis patients than for the general population.

Other examples of renal-related conditions that contribute to morbidity and mortality include, but are not limited to, polycystic kidney disease (PKD), nephrolithiasis, and lupus nephritis. PKD is a genetic disorder characterized by the growth of numerous cysts in the kidneys. About one-half of people with the most common type of PKD progress to kidney failure or ESRD. In the United States, about 600,000 people have PKD, and cystic disease is the fourth leading cause of kidney failure.³ 

Nephrolithiasis, or kidney stones, is the most common chronic kidney condition, after hypertension, and affects over 5 percent of adults in the United States, and the prevalence and incidence continues to rise. Kidney stones are a preventable cause of morbidity, accounting for over 5 billion dollars in economic costs each year. ⁴ Lupus nephritis, inflammation of the kidneys caused by systemic lupus erythematosus (SLE), accounts for 10 percent to 30 percent of patients diagnosed with ESRD. Medical evidence has shown that up to 60 percent of adults and 80 percent of children with SLE develop nephritis.⁵   Incidence rates of ESRD due to hereditary diseases and other rare conditions such as Fabry’s disease and Alport syndrome remains very low and has changed little in the past decade.¹ 

Previously, NQF has endorsed 32 consensus standards to evaluate the quality of care for renal-related diseases 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 designed to improve the quality of care delivered to patients with renal diseases in all care settings, including dialysis facilities, in-home settings, physician offices, and hospitals.

About the Project

The call for measures for this project will begin in May 2011.

Objectives

This project seeks to identify and endorse measures for public reporting and quality improvement that specifically address CKD, ESRD, and other important renal-related conditions such as PKD, nephrolithiasis, and lupus nephritis. NQF will solicit measures applicable to any healthcare setting and utilize any data sources. Measures that are harmonized across settings (e.g., in-center and home dialysis) are preferred.

Additionally, as part of this process, renal related consensus standards that were endorsed by NQF before June 2008 will be evaluated under the maintenance process. Endorsement maintenance provides the opportunity to harmonize specifications and to ensure that an endorsed measure represents the best in class.

NQF Process

The candidate measures will be considered for NQF endorsement as voluntary consensus standards. Agreement around the recommendations will be developed through NQF’s formal Consensus Development Process (CDP). This project will involve the active participation of representatives from across the spectrum of healthcare stakeholders and will be guided by a multiple-stakeholder Steering Committee.

Funding

This project is supported under a contract provided by the Department of Health and Human 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 email at renal@qualityforum.org.

Notes

1. U.S. Renal Data System, USRDS 2010 Annual Data Report: Atlas of Chronic Kidney Disease and 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 March 2011.
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.
3. Polycystic Kidney Disease: National Kidney and Urologic Diseases Information Clearinghouse, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2009. Available at http://kidney.niddk.nih.gov/kudiseases/pubs/polycystic/ Last accessed April 2011.
4. Worcester EM, Coe FL, Nephrolithiasis, Journal of Primary Care, 2008 June;35(2):369-91, vii.
5. Costenbader, KH, et al, Trends in the Incidence, Demographics and Outcomes of End-Stage Renal Disease Due to Lupus Nephritis in the U.S., 1995-2006, Journal of Arthritis & Rheumatism, Published Online: March 28, 2011 (DOI: 10.1002/art.30350). http://doi.wiley.com/10.1002/art.30293.