CKD Progression and Economic Burden in Individuals with CKD Associated with Type 2 Diabetes
Kidney Medicine, 2022
Rationale & objective
To evaluate progression patterns and associated economic outcomes, using estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (UACR) based on the Kidney Disease: Improving Global Outcomes (KDIGO) risk categories, among patients with type 2 diabetes (T2D) and chronic kidney disease (CKD).
Study design
Patients with T2D and moderate- or high-risk CKD were selected from the Optum electronic health records database (January 2007-December 2019). Progression patterns and post-progression economic outcomes were assessed.
Setting & participants
Adults with T2D and CKD in clinical settings.
Predictor
Baseline KDIGO risk categories.
Outcomes
Progression to a more severe KDIGO risk category; healthcare resource utilization and medical costs.
Analytical approach
Progression probability was estimated using cumulative incidence. Healthcare resource utilization and costs were compared across progression groups.
Results
Of 269,187 patients (mean age 65.6 years) with T2D and CKD of moderate or high baseline risk, 18.9% progressed to the very high-risk category within 5 years. Among moderate-risk patients, 17.8% of CKD stage G1-A2, 44.0% of stage G2-A2, and 61.3% of stage G3a-A1 patients progressed to a higher KDIGO risk category. Among high-risk patients, 63.9% of stage G3b-A1/G3a-A2 and 56.0% of stage G2-A3 patients progressed to very high risk. Within the same eGFR stage, a higher UACR stage was associated with 4- to 7-times higher risk of progressing to very high risk and faster eGFR decline. Nonprogressors had lower annual medical costs ($16,924) than patients who progressed from moderate risk to high risk ($22,117, P < 0.05), from high risk to very high risk ($32,204, P < 0.05), and from moderate risk to very high risk ($35,092, P < 0.05).
Limitations
Infrequent lab testing might have caused lags in identifying progression; medical costs were calculated using unit costs.
Conclusions
Patients with T2D and CKD of moderate or high risk per KDIGO risk categories had high probabilities of progression, incurring a substantial economic burden. The results highlight the value of UACR in CKD management.
Authors
Mullins CD, Pantalone KM, Betts KA, Song J, Wu A, Chen Y, Kong SX, Singh R