Quality indicators and clinical outcomes: the role of care quality in nondiabetic chronic kidney disease management

Quality indicators (QIs) are essential for evaluating healthcare quality, but their validation for nondiabetic chronic kidney disease (CKD) populations is limited. We aimed to assess the association between QIs and outcomes in nondiabetic CKD patients. Using Taiwan's National Health Insurance claims data and death registries, we analyzed 27,842 nondiabetic adults with stage 3B-5 CKD from 2016 to 2019. Three QIs were assessed: renin-angiotensin system (RAS) inhibitor prescription, proteinuria testing, and nonsteroidal anti-inflammatory drug (NSAID) avoidance. Each patient received an overall QI score (range: 0-3) based on the sum of the individual QI scores. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between QI scores and outcomes, including long-term dialysis, all-cause death, hospitalization for acute kidney injury (AKI), hyperkalemia, and acidosis. The study population had a mean age of 68.7 years and a female prevalence of 41.7%. Only 33.5% of patients received the highest QI score. During a median follow-up period of 23 months, higher overall QI scores were associated with lower risks of long-term dialysis (HR 0.891, 95% CI 0.846-0.938), all-cause death (HR 0.900, 95% CI 0.864-0.939), and acidosis (HR 0.882, 95% CI 0.799-0.972). Notably, the prescription of RAS inhibitors was consistently correlated with better outcomes. These findings underscore the importance of quality indicators, particularly the continued use of RAS inhibitors, in improving outcomes for nondiabetic CKD patients. Future research should focus on refining existing QIs and expanding their validation to broader populations and healthcare settings.