Chronic kidney disease and cardiovascular disease in the Medicare population.
BACKGROUND
The extent of diabetes, chronic kidney disease (CKD), and cardiovascular disease (CVD) in the Medicare population is relatively unknown. Also unknown is the effect of these diseases on patient survival before end-stage renal disease (ESRD).


METHODS
Prevalent cohorts of Medicare enrollees from 1996 to 2000 were assessed for diabetes and CKD, presence of CVD, and probability of death versus ESRD in the follow-up period. Hospitalization rates and, in diabetics, lipid testing and glycemic control monitoring were also assessed.


RESULTS
The prevalence of diabetes in the Medicare population increased at 4.4% per year, reaching 18.9% in the 1999-2000 cohort. Approximately 726,000 elderly Medicare enrollees carry a diagnosis code for CKD. Those with CKD are 5 to 10 times more likely to die before reaching ESRD than the non-CKD group. In CKD patients, CVD is twice as common and advances at twice the rate. Cardiovascular disease advances at a similarly higher rate in CKD patients who die and those who survive to ESRD. Heart failure hospitalizations are 5 times greater in CKD patients and only 30% less than those in dialysis patients. Only half of the CKD patients with diabetes who advance to ESRD had a lipid or glycosylated hemoglobin test done in the year before or after dialysis initiation.


CONCLUSIONS
Diabetes, the leading cause of ESRD, is increasing in the general Medicare population at 4.4% per year. Cardiovascular disease is common, progresses at twice the rate, is associated with death before ESRD, and patients receive suboptimal risk factor monitoring. Active identification and treatment of CKD patients is needed.
Collins
Allan J
AJ
United States Renal Data System, Minneapolis, Minnesota 55404, USA. acollins@usrds.org
Li
Shuling
S
Gilbertson
David T
DT
Liu
Jiannong
J
Chen
Shu-Cheng
SC
Herzog
Charles A
CA
D006333:Heart Failure / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000453:epidemiology*; D006278:Medicare / Q000706:statistics & numerical data*; D017202:Myocardial Ischemia / Q000453:epidemiology*; D015995:Prevalence; D012307:Risk Factors; D014481:United States / Q000453:epidemiology