Concept: Renal Failure
Last Updated: 2011-11-18
Definition of Renal Failure
Renal failure is the loss of the kidneys ability to remove wastes, concentrate urine, and maintain electrolytes levels in the blood. At MCHP, our definition of renal failure includes both acute and chronic renal failure. Renal disease associated with some other conditions, along with renal failure due to trauma, pregnancy and labour have typically not been included in our definition.
Renal Failure can be identified from the hospital abstracts data using ICD codes, or from the medical services (physician claims) data using ICD codes or tariff codes.
Identification Using Diagnoses Codes
Fransoo et al. (2005),
renal failure was identified using the following ICD codes from hospital discharge abstract and medical services/physician claims data:
Acute renal failure (ICD-9-CM: 584; ICD-10: N17)
Chronic renal failure (ICD-9-CM: 585; ICD-10: N18), or
- Renal failure unspecified (ICD-9-CM: 586; ICD-10: N19)
renal failure following labour and delivery, trauma, post procedure, and hypertension associated renal disease (ICD-9-CM codes: 403.x1, 404.x2 and ICD-10-CA codes: I12 or I13),
- congenital renal failure (ICD-10: P96.0)
unspecified disorder of kidney and ureter (ICD-9-CM: 593.9; ICD-10-CA: N28.9);
Diabetes with renal malfunctions (ICD-9-CM: 250.4);
Diabetes mellitus with renal complications (ICD-10-CA: E10.2);
Gouty nephropathy (ICD-9-CM: 274.1); and
- Disorders of calcium metabolism (ICD-9-CM: 275.4; ICD-10-CA: E83.5)
Renal Transplant: tariff code: 5883;
Transplant of Kidney (ICD-9-CM: 55.6; CCI code: 1.PC.85.^^);
- Procurement, pancreas with duodenum and kidney (CCI code: 1.OK.85.^^)
Renal failure is often a complication of diabetes, but can have other causes as well. It is expressed as a percentage because each resident is defined either as having been treated for renal failure, or not, in a period of time. Values are typically age-adjusted to reflect the Manitoba population age 20 and older (males and females combined).
The following diagnoses codes were excluded from the definition:
Other renal disease codes referenced in the literature, but not used in our definition included:
Kidney transplant and/or death has been identified as an endpoint through surgical physician tariff codes or from hospital procedure codes:
Lix et al. (2006) looked at renal failure as a possible chronic disease but it was not included in the final report as there was no data source for validation.
Identification Using Physician Tariff Codes
Dialysis has also been looked as a possibility to identify individuals with renal failure using medical services/physician claims data. In
Martens et al. (2010),
, the following tariff codes were used to identify initiation and subsequent dialysis. Follow-up dialysis may not be billed consistently in the medical services data across all years. Dialysis (ICD-9-CM diagnosis V56, procedure 39.95, ICD-10-CA Z49.1) generally will not be found in Manitoba hospital discharge abstracts data unless it is part of an inpatient stay.
In a study of adult obesity in Manitoba, Fransoo et al. (2011) also used the tariff codes listed above to identify participants who began dialysis treatment.
Manitoba Tariff Code Tariff Code Description
9798 ACUTE RENAL FAILURE Initial hemodialysis - See Rules 44 and 45
9799 ACUTE RENAL FAILURE subsequent hemodialysis, each
9801 CHRONIC RENAL FAILURE Initial hemodialysis - See Rules 44 and 45
9802 CHRONIC RENAL FAILURE subsequent hemodialysis, each
9805 ACUTE RENAL FAILURE Initial peritoneal dialysis, complete medical management, up to two (2) weeks
9807 ACUTE RENAL FAILURE subsequent (peritoneal) dialysis, after two (2) weeks
9806 CHRONIC RENAL FAILURE Initial peritoneal dialysis, first twenty-four (24) hours
9819 CHRONIC RENAL FAILURE Intermittent subsequent (peritoneal) dialysis (maximum $180.00 per week)
9821 CHRONIC RENAL FAILURE Home dialysis and self-care dialysis and self-care dialysis weekly retainer
9610 Chronic ambulatory peritoneal dialysis, in hospital, per day
9820 Home (peritoneal) dialysis and self-care dialysis weekly retainer for administration, routine visits, and supervision Note: The above fee is not applicable if the patient is admitted to hospital as an in-patient.
In Hilderman et al. (2011), they investigated chronic renal failure using the following MB tariff codes: 9801, 9802, 9806, 9819, 9821, 9610 or 9820.
In Chartier et al. (2012) the tariff codes listed in the table above were used to identify residents aged 19 and older who began dialysis treatment in a five-year period.
Cautions / Limitations
This concept and the associated SAS code should be considered a starting point for any study looking at renal failure. Issues around the use of acute and chronic conditions as well as additional codes should be reviewed and discussed prior to starting any analyes.
- Dialysis Treatment Start and Dialysis Treatment End
- End Stage Kidney Disease (ESKD)
- Risk of Chronic Kidney Disease (CKD) Progression to End Stage Kidney Disease (ESKD) - Heat Map
- Canadian Classification of Health Interventions (CCI)
- Diabetes / Diabetes Mellitus
- Dialysis Initiation
- Hospital Abstracts Data
- International Classification of Diseases, 10th Revision, with Canadian Enhancements (ICD-10-CA)
- Medical Services / Medical Claims Data
- Renal Disease
- Renal Failure
- Renal Failure Treatment Prevalence
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- Fransoo R, Martens P, Prior H, Chateau D, McDougall C, Schultz J, McGowan K, Soodeen R, Bailly A. Adult Obesity in Manitoba: Prevalence, Associations, and Outcomes. Winnipeg, MB: Manitoba Centre for Health Policy, 2011. [Report] [Summary] (View)
- Fransoo R, Martens P, The Need to Know Team, Burland E, Prior H, Burchill C, Chateau D, Walld R. Sex Differences in Health Status, Health Care Use, and Quality of Care: A Population-Based Analysis for Manitoba's Regional Health Authorities. Winnipeg, MB: Manitoba Centre for Health Policy, 2005. [Report] [Summary] [Additional Materials] (View)
- Hilderman T, Katz A, Derksen S, McGowan K, Chateau D, Kurbis C, Allison S, Reimer JN. Manitoba Immunization Study. Winnipeg, MB: Manitoba Centre for Health Policy, 2011. [Report] [Summary] (View)
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- Martens PJ, Bartlett J, Burland E, Prior H, Burchill C, Huq S, Romphf L, Sanguins J, Carter S, Bailly A. Profile of Metis Health Status and Healthcare Utilization in Manitoba: A Population-Based Study. Winnipeg, MB: Manitoba Centre for Health Policy, 2010. [Report] [Summary] [Updates and Errata] [Additional Materials] (View)
- Health Measures
Manitoba Centre for Health Policy
Community Health Sciences, Max Rady College of Medicine,
Rady Faculty of Health Sciences,
Room 408-727 McDermot Ave.
University of Manitoba
Winnipeg, MB R3E 3P5 Canada