percent of Medicare beneficiaries with a diabetes diagnosis are not screened for kidney-damage (albuminuria), and approximately 93 Page 10 | Advancing American Kidney Health percent of those with hypertension only (a risk factor for kidney disease) are not being tested for this disease.32 CDC is collaborating with NIH on the Longitudinal Study of Markers of Kidney Disease, and with the National Centers for Health Statistics to investigate and validate new markers for early kidney disease and identify new treatment options for diabetes-related kidney disease. Find more information on the Longitudinal Study of Markers of Kidney Disease at: https://www.cdc. gov/kidneydisease/about-the-ckd-initiative.html ▶ The NIH-funded Kidney Precision Medicine Project seeks to uncover the biological root causes of kidney disease through high throughput molecular, genetic, and cellular techniques from research kidney biopsies. This will lead to new biomarkers, disease subgroups, molecular targets, and most importantly the development of new drugs to treat and possibly forestall kidney disease. Recruitment of patients for renal biopsy will start in Summer 2019. Find more information on the NIH-funded Kidney Precision Medicine Project at: https://www.niddk.nih. gov/research-funding/research-programs/kidney-precision-medicine-project-kpmp ▶ The NIH-funded Preventing Early Renal Loss in Diabetes (PERL) Study is a randomized, double-blind trial to test whether the medication allopurinol can slow the progression of kidney disease in people with type 1 diabetes and early diabetic kidney disease. Results from this study are expected to be available at the end of 2019. Find more information about PERL at: http://www.perl-study.org/ ▶ Identification of patients with CKD for population health management, research and surveillance using data available in electronic health records (EHRs) is challenged by poor recognition and resulting under-diagnosis of the disease, particularly in its early stages. As a result, diagnosis codes cannot be used to accurately identify patients with CKD from the EHR. The NIH convened researchers, clinicians, and informaticists to develop and validate an electronic phenotype for CKD. An electronic phenotype is a defined set of data elements and rules that help identify groups of patients using a computerized query. The resulting NIH CKD phenotype uses laboratory measures commonly available in the EHR to identify patients likely to have CKD. Find more information on the electronic phenotype at: https://www.niddk.nih.gov/health-information/ communication-programs/nkdep/working-groups/health-information-technology Looking forward, HHS will further intensify its efforts to make kidney disease detection more accessible, including: ▶ As part of its CKD Initiative, CDC will continue to collaborate with other government agencies, universities, and national organizations to support a robust portfolio of epidemiological studies, including cost-effectiveness studies of the long-term efficacy of public health interventions for CKD, and the Systematic Review on Barriers to CKD Screening Project, which identifies and synthesizes current evidence on kidney disease screening and screening rates in the United States. These activities support efforts to raise awareness of CKD and its complications, promote prevention and control of risk factors for CKD, and improve early diagnosis and treatment among people living with kidney disease. ▶ The CKD Epidemiology in the Military Health System (MHS), a collaborative effort between the CDC and the Uniformed Services University of the Health Sciences, aims to describe the epidemiology of kidney disease among the active duty and non-active duty populations and assess their risk factors for developing kidney disease. Specifically, this project examines 1) Page 11 | Advancing American Kidney Health the effects of maintaining good physical and psychological health on risk of CKD, and 2) the long-term effects of non-sedentary lifestyle on risk of chronic conditions, including CKD. Because the project includes non-active duty persons, i.e., family members of active duty individuals and retirees from active duty, the findings will have implications beyond military personnel. Find more information on CKD Epidemiology in the MHS at: https://www.cdc.gov/kidneydisease/ about-the-ckd-initiative.html OBJECTIVE 2. Encourage adoption of evidence-based interventions to delay or stop progression to kidney failure In the United States, 30 million individuals have diabetes, 84 million adults have prediabetes (are at high risk for type 2 diabetes), and 75 million adults have high blood pressure.33,34 HHS has supported the development of several evidence-based national models for better managing kidney disease and risk factors for its progression. These models aim to reduce the national rate of kidney failure. ▶ American Indian/Alaska Native (AI/AN) populations have the highest prevalence of diabetes of any U.S. racial/ethnic group.35 The Special Diabetes Program for Indians (SDPI) represents an important part of this broader approach to providing team-based care and care management. The program has included a number of different components over time such as community directed grants that focus on locally developed solutions to improve diabetes prevention and