Chronic kidney disease, SSDI Claims in South Dakota

Medical criteria

SSA Blue Book listing

6.05 Chronic kidney disease,

Listing criteria (20 CFR Appendix 1, Part A)

with impairment of kidney function, with A and B: A. Reduced glomerular filtration evidenced by one of the following laboratory findings documented on at least two occasions at least 90 days apart during a consecutive 12-month period: 1. Serum creatinine of 4 mg/dL or greater; or 2. Creatinine clearance of 20 ml/min. or less; or 3. Estimated glomerular filtration rate (eGFR) of 20 ml/min/1.73m 2 or less. AND B. One of the following: 1. Renal osteodystrophy (see 6.00C3) with severe bone pain and imaging studies documenting bone abnormalities, such as osteitis fibrosa, osteomalacia, or pathologic fractures; or 2. Peripheral neuropathy (see 6.00C4); or 3. Fluid overload syndrome (see 6.00C5) documented by one of the following: a. Diastolic hypertension greater than or equal to diastolic blood pressure of 110 mm Hg despite at least 90 consecutive days of prescribed therapy, documented by at least two measurements of diastolic blood pressure at least 90 days apart during a consecutive 12-month period; or b. Signs of vascular congestion or anasarca (see 6.00C6) despite at least 90 consecutive days of prescribed therapy, documented on at least two occasions at least 90 days apart during a consecutive 12-month period; or 4. Anorexia with weight loss (see 6.00C7) determined by body mass index (BMI) of 18.0 or less, calculated on at least two occasions at least 90 days apart during a consecutive 12-month period.

Body system category

6.00 Genitourinary disorders

Common denial reason

CKD claims with nephrotic-range proteinuria are commonly denied when proteinuria levels or duration do not meet required laboratory criteria.