title: End-Stage Renal Disease Outcomes among the Kaiser Permanente Southern California Creatinine Safety Program (Creatinine SureNet): Opportunities to Reflect and Improve.
abstract: The Kaiser Permanente Southern California (KPSC) creatinine safety program (Creatinine SureNet) identifies and outreaches to thousands of people annually who may have had a missed diagnosis for chronic kidney disease (CKD). We sought to determine the value of this outpatient program and evaluate opportunities for improvement.
  
  
  
  Longitudinal cohort study (February 2010 through December 2015) of KPSC members captured into the creatinine safety program who were characterized using demographics, laboratory results, and different estimations of glomerular filtration rate. Age- and sex-adjusted rates of end-stage renal disease (ESRD) were compared with those in the overall KPSC population.
  
  
  
  Among 12,394 individuals, 83 (0.7%) reached ESRD. The age- and sex-adjusted relative risk of ESRD was 2.7 times higher compared with the KPSC general population during the same period (94.7 vs 35.4 per 100,000 person-years; p < 0.001). Screening with the Chronic Kidney Disease Epidemiology Collaboration (vs Modification Diet in Renal Diseases) equation would capture 44% fewer individuals and have a higher predictive value for CKD. Of those who had repeated creatinine measurements, only 13% had a urine study performed (32% among patients with confirmed CKD).
  
  
  
  Our study found a higher incidence of ESRD among individuals captured into the KPSC creatinine safety program. If the Chronic Kidney Disease Epidemiology Collaboration equation were used, fewer people would have been captured while improving the accuracy for diagnosing CKD. Urine testing was low even among patients with confirmed CKD. Our findings demonstrate the importance of a creatinine safety net program in an integrated health system but also suggest opportunities to improve CKD care and screening.
authors.affiliation: Nephrologist at the Los Angeles Medical Center in CA. john.j.sim@kp.org.
authors.forename: John J
authors.initials: JJ
authors.lastname: Sim
authors.affiliation: Biostatistician in the Department of Research and Evaluation for Kaiser Permanente Southern California in Pasadena. michael.batech@kp.org.
authors.forename: Michael
authors.initials: M
authors.lastname: Batech
authors.affiliation: Research Scientist in the Department of Research and Evaluation for Kaiser Permanente Southern California in Pasadena. E- mail: kim.n.danforth@kp.org.
authors.forename: Kim N
authors.initials: KN
authors.lastname: Danforth
authors.affiliation: Nephrologist at the Baldwin Park Medical Center in Baldwin Park, CA. mark.p.rutkowski@kp.org.
authors.forename: Mark P
authors.initials: MP
authors.lastname: Rutkowski
authors.affiliation: Director of Research in the Department of Research and Evaluation for Kaiser Permanente Southern California in Pasadena. steven.j.jacobsen@kp.org.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Jacobsen
authors.affiliation: Medical Director for Quality and Clinical Analysis for the Southern California Permanente Medical Group in Pasadena. michael.h.kanter@kp.org.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Kanter
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002140:California; D015331:Cohort Studies; D003404:Creatinine / Q000652:urine*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000517:prevention & control / Q000652:urine; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D015397:Program Evaluation; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis* / Q000652:urine; D012307:Risk Factors; D012449:Safety; D055815:Young Adult
chemical_list: D003404:Creatinine