Skip to main content
  • Measure Summary
  • NQMC:000347
  • Oct 2002

Advanced chronic kidney disease (CKD): percent of patients prescribed vitamin D2.

Renal Physicians Association. Appropriate patient preparation for renal replacement therapy. Rockville (MD): Renal Physicians Association; 2002 Oct 1. 78 p. (Clinical Practice Guideline; no. 3).

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in March 2016.

Primary Measure Domain

Clinical Quality Measures: Process

Secondary Measure Domain

Does not apply to this measure

Description

This measure assesses the percent of patients prescribed vitamin D2 among patients with advanced chronic kidney disease (CKD) and immunoreactive parathyroid hormone (iPTH) greater than 100 pg/mL (or greater than 1.5 times the upper limit of normal for each assay used) and vitamin D level less than 30 ng/mL.

Rationale

Renal osteodystrophy is a complex and multifaceted disease process that begins early in the course of chronic kidney disease (CKD) and is a major, long-term complication associated with high rates of morbidity. The metabolic and skeletal derangements associated with renal osteodystrophy are not easily reversed and, therefore, early interventions are crucial.

Serum levels of 1,25(OH)2D correlate with 25(OH)D in CKD stage 3 and 4, indicating that the generation of 1,25(OH)2D in CKD patients depends on supply of 25(OH)D. Patients with CKD are more likely than non-CKD patients to have 25(OH)D levels less than 30 ng/mL. Levels of 25(OH) vitamin D less than 30 ng/mL but within the normal range have been associated with elevated immunoreactive parathyroid hormone (iPTH) levels in the elderly, and levels less than 15 ng/mL have been associated with a greater severity of secondary hyperparathyroidism (HPTH) in end-stage renal disease (ESRD) patients. Therapy may reduce fracture risk in the elderly.

Evidence for Rationale

Ghazali A, Fardellone P, Pruna A, Atik A, Achard JM, Oprisiu R, Brazier M, Remond A, Moriniere P, Garabedian M, Eastwood J, Fournier A. Is low plasma 25 (OH) vitamin D a major risk factor for hyperparathyroidism and Looser's zones independent of calcitriol?. Kidney Int. 1999 Jun;55(6):2169-77. PubMed External Web Site Policy

Ishimura E, Nishizawa Y, Inaba M, Matsumoto N, Emoto M, Kawagishi T, Shoji S, Okuno S, Kim M, Miki T, Morii H. Serum levels of 1,25-dihydroxyvitamin D, 24,25-dihydroxyvitamin D, and 25-hydroxyvitamin D in nondialyzed patients with chronic renal failure. Kidney Int. 1999 Mar;55(3):1019-27. PubMed External Web Site Policy

Reichel H, Deibert B, Schmidt-Gayk H, Ritz E. Calcium metabolism in early chronic renal failure: implications for the pathogenesis of hyperparathyroidism. Nephrol Dial Transplant. 1991;6(3):162-9. PubMed External Web Site Policy

Renal Physicians Association. Appropriate patient preparation for renal replacement therapy. Rockville (MD): Renal Physicians Association; 2002 Oct 1. 78 p. (Clinical Practice Guideline; no. 3).

Thomas MK, Lloyd-Jones DM, Thadhani RI, Shaw AC, Deraska DJ, Kitch BT, Vamvakas EC, Dick IM, Prince RL, Finkelstein JS. Hypovitaminosis D in medical inpatients. N Engl J Med. 1998 Mar 19;338(12):777-83. PubMed External Web Site Policy

Primary Health Components

Advanced chronic kidney disease; renal osteodystrophy; immunoreactive parathyroid hormone; 25(OH) vitamin D; vitamin D insufficiency

Denominator Description

The number of adult patients with advanced chronic kidney disease (CKD), not currently receiving renal replacement therapy, with immunoreactive parathyroid hormone (iPTH) greater than 100 pg/mL (or greater than 1.5 times the upper limit of normal for each assay used) and vitamin D level less than 30 ng/mL

Numerator Description

The number of patients from the denominator prescribed vitamin D2

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A clinical practice guideline or other peer-reviewed synthesis of the clinical research evidence
  • A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences
  • A systematic review of the clinical research literature (e.g., Cochrane Review)

Additional Information Supporting Need for the Measure

Levels of 25(OH) vitamin D less than 30 ng/mL but within the normal range have been associated with elevated immunoreactive parathyroid hormone (iPTH) levels in the elderly, and levels less than 15 ng/mL have been associated with a greater severity of secondary hyperparathyroidism (HPTH) in end-stage renal disease (ESRD) patients.

Evidence for Additional Information Supporting Need for the Measure

Ghazali A, Fardellone P, Pruna A, Atik A, Achard JM, Oprisiu R, Brazier M, Remond A, Moriniere P, Garabedian M, Eastwood J, Fournier A. Is low plasma 25 (OH) vitamin D a major risk factor for hyperparathyroidism and Looser's zones independent of calcitriol?. Kidney Int. 1999 Jun;55(6):2169-77. PubMed External Web Site Policy

Extent of Measure Testing

Unspecified

State of Use

Current routine use

Current Use

Internal quality improvement

Measurement Setting

Ambulatory/Office-based Care

Hospital Outpatient

Professionals Involved in Delivery of Health Services

Physicians

Least Aggregated Level of Services Delivery Addressed

Individual Clinicians or Public Health Professionals

Statement of Acceptable Minimum Sample Size

Unspecified

Target Population Age

Age greater than or equal to 18 years

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Living with Illness

IOM Domain

Effectiveness

Case Finding Period

Unspecified

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Clinical Condition

Patient/Individual (Consumer) Characteristic

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
Adult patients age 18 years and older with chronic kidney disease stage 4 or 5 (glomerular filtration rate [GFR] less than or equal to 30 mL/min/1.73 m2), not currently receiving renal replacement therapy, with immunoreactive parathyroid hormone (iPTH) greater than 100 pg/mL (or greater than 1.5 times the upper limit of normal for each assay used) and vitamin D level less than 30 ng/mL

Exclusions
Unspecified

Exclusions/Exceptions

Unspecified

Numerator Inclusions/Exclusions

Inclusions
The number of patients from the denominator prescribed vitamin D2*

*Prescribed vitamin D dosage is vitamin D2 50,000 units orally every month for six months.

Exclusions
Unspecified

Numerator Search Strategy

Episode of care

Data Source

Administrative clinical data

Laboratory data

Paper medical record

Pharmacy data

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

Unspecified

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Unspecified

Standard of Comparison

Internal time comparison

Original Title

Number of patients prescribed vitamin D2 / number of patients with advanced CKD and iPTH greater than 100 pg/mL (or greater than 1.5 times the upper limit of normal for each assay used) and vitamin D level less than 30 ng/mL.

Measure Collection Name

Clinical Performance Measures on Appropriate Patient Preparation for Renal Replacement Therapy

Measure Set Name

Bone Disease Recommendations

Submitter

Renal Physicians Association

Developer

Renal Physicians Association

Funding Source(s)

Ortho Biotech Products, LP

Composition of the Group that Developed the Measure

W. Kline Bolton, MD, Working Group Chair, University of Virginia School of Medicine, Charlottesville, VA; William F. Owen, Jr., MD, President, RPA, Duke University School of Medicine Durham, NC; Baxter Healthcare Corp., McGaw Park, IL; Dale Singer, MHA, Executive Director, RPA.

Content Experts: Jack Coburn, MD, UCLA School of Medicine, West Los Angeles V.A. Healthcare Center, West Los Angeles, CA; William Haley, MD, Mayo Clinic, Jacksonville, FL; Annamaria Kausz, MD, New England Medical Center, Boston, MA; Adeera Levin, MD, St. Paul's Hospital, Vancouver, BC; William Mitch, MD, University of Texas Medical Branch, Galveston, TX; Patricia Painter, PhD, University of California, San Francisco, CA; Michael Rocco, MD, MSCE, Wake Forest University School of Medicine, Winston-Salem, NC.

Association Representatives: Carolyn Atkins, RN, BS, CCTC, National Kidney Foundation, Medical City Dallas Hospital, Dallas, TX; Shelley Clark, RN, National Renal Administrators Association, FMC North Roanoke Dialysis, Roanoke, VA; Paul Eggers, PhD, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Bethesda, MD; Lori Fedje, RD, LD, NKF Council on Renal Nutrition, Pacific Northwest Renal Services, Portland, OR; Richard Goldman, MD, Renal Physicians Association, Renal Medicine Associates, Emeritus Albuquerque, NM; Joel Greer, PhD, Centers for Medicare and Medicaid Services, Baltimore, MD; Richard Lafayette, MD, American Society of Nephrology, Stanford University School of Medicine, Stanford, CA; Eugene Z. Oddone, MD, American College of Physicians - American Society of Internal Medicine, Durham VA Medical Center, Durham, NC; Victoria Norwood, MD, American Society of Pediatric Nephrology, University of Virginia, Charlottesville, VA; Paul M. Palevsky, MD, Forum of ESRD Networks, University of Pittsburgh School of Medicine, VA Pittsburgh Health Care System, Pittsburgh, PA; Sandy Peckens, MSW, NKF Council of Nephrology Social Workers, Merrimack Valley Nephrology, Methuen, MA; Venkateswara Rao, MD, American Society of Transplantation, Hennepin County Medical Center, Minneapolis, MN; Charlotte Thomas Hawkins, PhD, RN, CNN, American Nephrology Nurses Association, Rutgers, The State University of New Jersey, Burlington, NJ; Joseph White, American Association of Kidney Patients.

Methodologists: David B. Matchar, MD, FACP, Director, Duke Center for Clinical Health Policy Research and Co-Director, Duke Evidence-based Practice Center, Durham, NC; Douglas C. McCrory, MD, MHS, Co-Director Duke Evidence-based Practice Center, Durham, NC; Joseph A. Coladonato, MD, Duke Institute of Renal Outcomes Research & Health Policy, Durham, NC; Preston S. Klassen, MD, MHS, Duke Institute of Renal Outcomes Research & Health Policy, Durham, NC; Meenal B. Patwardhan, MD, MHSA, Duke Center for Clinical Health Policy Research and Duke Evidence-based Practice Center, Durham, NC; Donal N. Reddan, MD, MHS, Duke Institute of Renal Outcomes Research & Health Policy, Durham, NC; Olivier T. Rutschmann, MD, MPH, Duke Center for Clinical Health Policy Research, Durham, NC; William S. Yancy, Jr., MD, MHS, Duke University Medical Center, Durham, NC.

Medical Editor: Rebecca N. Gray, DPhil, Duke Evidence-based Practice Center, Durham, NC.

Project Manager and Editor: Emily G. Shurr, MA, Duke Evidence-based Practice Center, Durham, NC.

Financial Disclosures/Other Potential Conflicts of Interest

There were none disclosed.

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2002 Oct

Measure Maintenance

Unspecified

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in March 2016.

Source(s)

Renal Physicians Association. Appropriate patient preparation for renal replacement therapy. Rockville (MD): Renal Physicians Association; 2002 Oct 1. 78 p. (Clinical Practice Guideline; no. 3).

Measure Availability

Source not available electronically.

For more information, contact the Renal Physicians Association (RPA) at 1700 Rockville Pike, Suite 220, Rockville, MD 20852; Phone: 301-468-3515; Fax: 301-468-3511; Web site: www.renalmd.org External Web Site Policy; E-mail: rpa@renalmd.org.

NQMC Status

This NQMC summary was completed by ECRI on May 23, 2003. The information was verified by the Renal Physicians Association on June 17, 2003.

This NQMC summary was retrofitted into the new template on May 6, 2011.

The information was reaffirmed by the measure developer on March 11, 2016.

Copyright Statement

This NQMC summary is based on the original measure, which is subject to the measure developer's copyright restrictions.

For more information, contact RPA at 1700 Rockville Pike, Suite 220, Rockville, MD 20852; phone: 301-468-3515; fax: 301-468-3511; Web site: www.renalmd.org External Web Site Policy; e-mail: rpa@renalmd.org.

NQMC Disclaimer

The National Quality Measures Clearinghouseâ„¢ (NQMC) does not develop, produce, approve, or endorse the measures represented on this site.

All measures summarized by NQMC and hosted on our site are produced under the auspices of medical specialty societies, relevant professional associations, public and private organizations, other government agencies, health care organizations or plans, individuals, and similar entities.

Measures represented on the NQMC Web site are submitted by measure developers, and are screened solely to determine that they meet the NQMC Inclusion Criteria which may be found at http://www.qualitymeasures.ahrq.gov/about/inclusion-criteria.aspx.

NQMC, AHRQ, and its contractor ECRI Institute make no warranties concerning the content or its reliability and/or validity of the quality measures and related materials represented on this site. Moreover, the views and opinions of developers or authors of measures represented on this site do not necessarily state or reflect those of NQMC, AHRQ, or its contractor, ECRI Institute, and inclusion or hosting of measures in NQMC may not be used for advertising or commercial endorsement purposes.

Readers with questions regarding measure content are directed to contact the measure developer.