A persistent and usually progressive, irreversible loss of kidney function.
Abnormalities are usually present > 3 months per KDIGO.
Often associated with
HTN
Urinary obstruction
Autoimmune diseases
Recurrent UTIs
Prior episodes of AKI
Diagnostic Criteria
The diagnostic criteria for CKD is the presence of either of the following for > 3 months:
| ▸ | Decreased GFR <60 ml/min, OR |
| ▸ | Objective measure of kidney damage-significant persistent albuminuria, hematuria, structural abnormalities noted on imaging. |
| ▸ | CKD stages 1 or 2 require the presence of one or more markers of kidney damage. A GFR >/= 60 is not CKD if there are no markers noted. |
| ▸ | CKD stages 3-5 are based on GFR alone. |
CKD Stages & Coding
Coding & CDI Considerations
There is an assumed relationship between:
| ▸ | ‘CKD5 requiring chronic dialysis’ codes to N18.6 (ESRD) per Excludes1 note. |
| ▸ | Patients receiving dialysis for ESRD should be assigned both N18.6 (ESRD) and Z99.2 (dependence on dialysis). |
Additional considerations
| ▸ | The stage of CKD should not be assigned until glomerular filtration rate (GFR) and/or creatinine (Cr) levels have stabilized. This is especially important in cases of acute kidney injury (AKI) superimposed on CKD, where staging may not be reliable until renal function has returned to baseline. In such scenarios, it is not appropriate to query for CKD staging. |
| ▸ | All patients with a history of kidney transplantation meet the definition of CKD, regardless of current GFR. However, CKD alone does not indicate a transplant complication and should not be coded as such unless explicitly documented. |
| ▸ | For patients with end-stage renal disease (ESRD) on dialysis, a diagnosis of AKI should not be assigned, as renal function is already non-recoverable. |
| ▸ | When applying Sepsis-3 criteria (SOFA score) in patients with CKD, always consider the patient’s baseline creatinine to avoid misclassification of organ dysfunction. |
| ▸ | The terms “chronic renal insufficiency,” “chronic renal failure,” and “chronic renal disease” are clinically acceptable and may be used interchangeably with CKD for coding purposes. |
Comorbidity and Risk Adjustment
Query Opportunity
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