Diabetes

Chronic kidney disease in individuals with diabetes mellitus (ages 18-84 years)

Individuals who had diabetic nephropathy (numerator), aged 18-84 years with diabetes (denominator)

Rational:

Diabetes is a complex group of diseases marked by high blood glucose (blood sugar) due to the body’s inability to make or use insulin. Left unmanaged, diabetes can lead to serious micro- and macro-vascular complications, including heart disease, stroke, hypertension, blindness, kidney disease, diseases of the nervous system, amputations and premature death [1]. Chronic kidney disease attributed to diabetes, occurs in 20–40% of patients with diabetes; in Israel, it is the leading cause of end-stage renal disease. The condition is diagnosed by the presence of elevated urinary albumin excretion (albuminuria), low estimated glomerular filtration rate (eGFR), or other manifestations of kidney damage. It is therefore recommended to document urinary protein levels and GFR for individuals with diabetes at least once a year. Upon diagnosis, it is recommended to optimize glucose and blood pressure control, in order to slow the progression of the kidney disease. Hypertension is a strong risk factor for the development and progression of diabetic kidney disease. Angiotensin-converting enzyme inhibitor or angiotensin receptor blocker (ACEI/ARBs) are the preferred first-line agents for blood pressure treatment among patients with diabetes, hypertension, and kidney disease, as they were shown to prevent the progression of kidney disease and prevent major cardiovascular events [2].

Numerator:

Individuals in the denominator who had diabetic nephropathy, defined according to the last value of: urinary protein (total protein value>150 mg/day, or microalbumin>30 mg/day, or albumin/creatinine ratio>30 mg/g, or total protein/creatinine ratio>200 mg/g); or blood creatinine>1.5 mg/dL (only if GFR value is unavaliable); or GFR/eGFR value<60 ml/min/1.73m2

Denominator

Individuals aged 18-84 years with diabetes who had at least one of the following test values documented in the year prior to the measurement year: total protein, microalbumin, albumin/creatinine ratio, total protein/creatinine ratio; or blood creatinine; or GFR/eGFR value.

Notes:

The definition of this measure is currently under revision, as it does not specifically exclude the relatively rare case of normotensive individuals with diabetic nephropathy

Notes:

[1] American Diabetes Association (ADA), “Standard of medical care in diabetes - 2017,” Diabetes Care, vol. 40 (sup 1), no. January, pp. s4–s128, 2017.
[2] American Diabetes Association. Microvascular complications and foot care. Sec. 10. In “Standards of Medical Care in Diabetes- 2017”. Diabetes Care 2017;40(Suppl. 1): S88–S98

Results:
Diabetic nephropathy by year
Diabetic nephropathy by socio-economic position (1-lowest, 4-highest) and sex


National Program for Quality Indicators in Community Healthcare
התכנית הלאומית למדדי איכות לרפואת הקהילה בישראל