Uploaded image for project: 'eCQM Issue Tracker'
  1. eCQM Issue Tracker
  2. CQM-7217

CMS951V2: KHE

XMLWordPrintable

    • Icon: EC eCQMs - Eligible Clinicians EC eCQMs - Eligible Clinicians
    • Resolution: Answered
    • Icon: Moderate Moderate
    • None
    • None
    • Hide
      Thank you for your question. For diabetes, albuminuria as the urinary albumin-creatinine ratio (uACR) test has long been the recommended screening test based on clinical practice guidelines from the American Diabetes Association, National Kidney Foundation and Kidney Disease Improving Global Outcomes (references for the clinical practice guidelines can be found at https://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS951v2.html). According to the measure steward, the National Kidney Foundation (NKF), urinary protein-creatinine ratio (uPCR) is often used interchangeably with uACR. Both predict outcomes similarly. Both tests may be performed at least initially to help distinguish non-albumin proteinuria (tubular or overflow/paraproteinuria). In addition, the guidelines for diabetes have also recently recommended a 30% reduction in albuminuria as a clinical target when the uACR is 300 mg/g or more for monitoring. Conversely, increases in albuminuria are important to detect of course.

      Further, the albuminuria therapeutic target recommendation is based on multiple recent high-quality randomized controlled trials in CKD and type-2 diabetes. These trials include Angiotensin Receptor Blockers (IDNT and RENAAL), SGLT2 inhibitors (CREDENCE, DAPA-CKD and EMPA-KIDNEY), Non-steroidal MRA (FIDELIO, FIGARO, FIDELITY), and GLP-1 RA (FLOW). There are also many active clinical trials, currently enrolling participants, that include albuminuria as an outcome in the analysis for both type-1 and type-2 diabetes. Prediction models, such as the CKD heat map and other validated prediction models (kidney failure risk equation and PREVENT cardiovascular risk calculator) also use albuminuria rather than proteinuria.
       
      The uACR is currently in the process of being standardized, whereas uPCR is not feasible to be standardized. In the future, there should be less bias for uACR across laboratory methods than uPCR.

      NKF is currently convening a Measurement of urinary proteins conference to assess the use of uACR versus uPCR for clinical trials and clinical practice, particularly for diseases other than diabetes in which there are less data for albuminuria (e.g glomerular diseases and pediatric kidney diseases).
      Show
      Thank you for your question. For diabetes, albuminuria as the urinary albumin-creatinine ratio (uACR) test has long been the recommended screening test based on clinical practice guidelines from the American Diabetes Association, National Kidney Foundation and Kidney Disease Improving Global Outcomes (references for the clinical practice guidelines can be found at https://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS951v2.html) . According to the measure steward, the National Kidney Foundation (NKF), urinary protein-creatinine ratio (uPCR) is often used interchangeably with uACR. Both predict outcomes similarly. Both tests may be performed at least initially to help distinguish non-albumin proteinuria (tubular or overflow/paraproteinuria). In addition, the guidelines for diabetes have also recently recommended a 30% reduction in albuminuria as a clinical target when the uACR is 300 mg/g or more for monitoring. Conversely, increases in albuminuria are important to detect of course. Further, the albuminuria therapeutic target recommendation is based on multiple recent high-quality randomized controlled trials in CKD and type-2 diabetes. These trials include Angiotensin Receptor Blockers (IDNT and RENAAL), SGLT2 inhibitors (CREDENCE, DAPA-CKD and EMPA-KIDNEY), Non-steroidal MRA (FIDELIO, FIGARO, FIDELITY), and GLP-1 RA (FLOW). There are also many active clinical trials, currently enrolling participants, that include albuminuria as an outcome in the analysis for both type-1 and type-2 diabetes. Prediction models, such as the CKD heat map and other validated prediction models (kidney failure risk equation and PREVENT cardiovascular risk calculator) also use albuminuria rather than proteinuria.   The uACR is currently in the process of being standardized, whereas uPCR is not feasible to be standardized. In the future, there should be less bias for uACR across laboratory methods than uPCR. NKF is currently convening a Measurement of urinary proteins conference to assess the use of uACR versus uPCR for clinical trials and clinical practice, particularly for diseases other than diabetes in which there are less data for albuminuria (e.g glomerular diseases and pediatric kidney diseases).
    • CMS0951v2

      We are a combined primary and specialty care group having difficulty with the KHE measure. The microalbumin/creatinine ratio is used for screening, however, when a patient is already diagnosed with CKD the providers typically use the PCR for monitoring because it is more specific. As this measure is primarily for screening it doesn't make sense to continue to screen with uACR if the patient already has a CKD diagnosis. In the past, the measure only included those who did not already have a CKD diagnosis or who were not on an ACE/ARB but since that has changed, we are having to do the uACR for everyone (except CKD 5 and ESRD since these are excluded). Is this something that will be looked at to possibly change in the future?

            AIR EC eCQM Team AIR EC eCQM Team
            KRACHEL Kasey Rachel (Inactive)
            Votes:
            0 Vote for this issue
            Watchers:
            4 Start watching this issue

              Created:
              Updated:
              Resolved:
              Solution Posted On: