Table A2.

Standards Specificity and Coverage of CKD Quality Measures

Proposed CKD Quality Measure from Mendu et al17	Specificity and Coverage of Relevant Standards from ISA
Annual eGFR monitoring, reported as percentage of patients with CKD stages 3‐5 who had at least 1 eGFR measured in the past 365 days.	Numerator well‐specified. LOINC to identify eGFR test result
Annual proteinuria monitoring, reported as percentage of patients with CKD stages 3‐5 with at least 1 urine protein measurement in the past 365 days.	Numerator well‐specified. LOINC to identify proteinuria test result
Annual assessment of nonsmoking rates, reported as percentage of patients with CKD stages 3‐5 with documentation of smoking status in the clinical record indicating never or former smoker in the past 365 days.	Numerator well‐specified. SNOMED CT and/or LOINC to assess smoking status per Meaningful Use standard40
Completion of nephrology referrals for patients with advanced CKD, reported as percentage of patients with CKD stages 4‐5 who have a documented referral, scheduled appointment, or completed visit with a nephrologist in the past 365 days.	Numerator underspecified. Professional guidelines establish varying thresholds for referral, without a clear standard.   Referral communication partially covered under 2017 NCQA Patient‐centered Medical Home Care Coordination Standards41 and Meaningful Use Stage 2 Core Measure 15 standards.42   No standard to ensure completed referral or closed loop communication.
Use of ACE inhibitor or ARB therapies for patients with CKD with diabetes mellitus, hypertension, or severely increased albuminuria, reported as percentage of ACE inhibitor/ARB‐eligible patients with CKD stages 3‐5 with a prescription, refill, or medication verification for ACE inhibitor or ARB in the past 365 days.	Numerator well‐specified. LOINC to identify albuminuria RxNorm to identify ACEi/ARB drug class   Denominator underspecified (no clear standard for diabetes mellitus phenotype)
Inappropriate use of unsafe medications in renal patients, reported as percentage of patients with CKD stages 3‐5 with at least 1 medication improperly dosed (includes metformin, lithium, Neurontin, atenolol, bisphosphonates, digoxin, nitrofurantoin, Rivaroxaban, trimethoprim‐sulfamethoxazole, and levofloxacin) in the past 365 days.	Numerator underspecified   RxNorm to identify unsafe meds (inclusion in of medications in the list is not universally agreed upon and “improper dosing” is ambiguous)
Completion of PROMs, reported as percentage of patients with CKD stages 3‐5 with PROMs captured in the EHR in the past 365 days.	Not specified in the ISA   Potential instruments include KDQOL, PROMIS. No established standard.
Blood pressure control, reported as percentage of patients with CKD stages 3‐5 with controlled blood pressure ([definitions given]) in the past 365 days.	Numerator underspecified. CMS eCQI 165v443 (multiple competing measures, with variation from current clinical HTN guidelines)
Limit erythrocyte stimulating agent (ESA) overuse, reported as percentage of patients with CKD stages 3‐5 for whom an ESA administered in the past 365 days and most recent hemoglobin, 11.5 g/dL measured within 30 days before ESA administration.	Numerator well specified.   LOINC to identify abnormal hemoglobin results RxNorm to identify erythrocyte stimulating agent usage.
Ensure dialysis informed decision making, reported as percentage of patients initiating dialysis therapy whose nephrologists attest within the EHR to completing informed decision‐making process in the past 365 days.	Numerator underspecified.   No standard means to capture informed decision making or education. LOINC panel 85597‐3 has been proposed.
Ensure timely fistula placement, reported as percentage of patients initiating dialysis therapy whose nephrologists attest within the EHR that the patient has a working fistula in the past 365 days.	Underspecified.   These data are captured on Medicare End‐stage Renal Disease Evidence Report Form 2728. No EHR‐based standard exists to our knowledge.
All‐cause mortality, reported as percentage of patients with CKD stages 3‐5 who died in the past 365 days.	Underspecified.   Unreliable electronic capture of out‐of‐hospital death data in real‐world practice.