Trends in Chronic Kidney Disease Screening and Diagnosis Among Medicare Enrollees

Support for this white paper was provided by Carson Smith, Elizabeth Montgomery, Miriam Godwin and Jesse Roach of the National Kidney Foundation. 

Early detection, diagnosis and treatment of chronic kidney disease (CKD) are critical to improving chronic disease outcomes in the United States. Recent research has identified improvements in CKD screening rates among Medicare enrollees, but less is known about whether these gains are translating into earlier stage diagnosis.

To address this gap, the National Kidney Foundation (NKF) worked with Manatt Health Strategies to analyze nationwide traditional Medicare fee-for-service (FFS) and Medicare Advantage claims from 2016 to 2023 to assess trends in comprehensive, guideline-concordant CKD screening and the stage at initial CKD identification among Traditional Medicare and Medicare Advantage beneficiaries.

Consistent with prior research, the team found screening rates increased over the study period. Among Traditional Medicare enrollees, annual rates of guideline-concordant screening (receipt of both quantitative urine albumin-to-creatinine ratio [uACR] and estimated glomerular filtration rate [eGFR] testing) rose from 17% in 2016 to 20% in 2023. Among Medicare Advantage enrollees, rates increased from 24% to 28% during the same period.

Over this timeframe, CKD incidence increased modestly by approximately one percentage point in both populations. The share of patients diagnosed at earlier stages (Stages 1 and 2) remained relatively stable. However, the proportion of newly diagnosed patients identified at Stage 3 increased, and the share of patients diagnosed with an unknown stage declined steadily.

These findings suggest that increases in population-level CKD screening rates have not yet translated into earlier-stage diagnosis at the population level. However, we did observe an improvement in the precision of CKD staging at the time of diagnosis, which may have been impacted by improved screening rates, as well as changes in coding norms, financial incentives and provider education.

Read the full report .