# Chronic kidney disease in older adults: trends in prevalence and healthcare service quality from 2012 to 2018

## TL;DR

This study shows that CKD prevalence in older adults in Germany increased from 2012 to 2018, but non-recommended drug prescriptions decreased, while diagnostic testing remained suboptimal.

## Contribution

The study introduces new quality indicators for CKD outpatient care and analyzes their trends over six years.

## Key findings

- CKD prevalence in older adults rose from 17.8% in 2012 to 25.7% in 2018.
- Non-recommended drug prescriptions for CKD dropped by more than half between 2012 and 2018.
- ACR and dipstick testing rates remained low and inconsistent, below recommended levels.

## Abstract

Data on the healthcare service quality for patients with chronic kidney disease (CKD) are vital for guiding practitioners, patients and healthcare policy makers. We examined new quality indicators for outpatient diagnostics and treatments in older patients with CKD, focusing on trends between 2012 and 2018.

The study included cross-sectional German statutory health insurance claims data from four independent random samples (2012, 2014, 2016, 2018), each with 62 200 individuals aged ≥70 years. We analyzed coded CKD prevalence and incidence, non-recommended drug prescriptions (dual prescriptions of angiotensin-converting enzyme inhibitors with angiotensin II receptor blockers; non-steroidal anti-inflammatory drugs in CKD stage 4–5), as well as albumin/creatinine ratio (ACR) and dipstick testing in incident CKD cases.

After standardization, the samples included 58.4%–59.3% females, and mean ages ranging from 77.4 to 78.9 years. CKD prevalence increased from 17.8% [95% confidence interval (CI) 17.5; 18.1] in 2012 to 25.7% (95% CI 25.4; 26.1) in 2018. CKD incidence rose slightly from 6.4% (95% CI 6.2; 6.6) to 7.6% (95% CI 7.4; 7.9). Non-recommended drug prescriptions, which were below 5% in 2012, decreased by more than half by 2018. ACR and dipstick testing varied inconsistently over time, ranging from 11.4% to 13.5% and 55.4% to 57.2%, respectively.

CKD prevalence in older adults in Germany rose by eight percentage points from 2012 to 2018 while prescriptions of non-recommended drugs decreased in patients with CKD, indicating better diagnosis and guideline adherence. However, ACR and dipstick diagnostic was alarmingly low, and remained below recommended levels outside kidney specialist care, showing areas for improvement.

Graphical Abstract