Economic burden of comorbid chronic kidney disease and diabetes.
OBJECTIVE
To estimate real-world healthcare utilization and expenditures across the spectrum of chronic kidney disease (CKD), as determined by estimated glomerular filtration rate (eGFR) categories in patients with diabetes.


METHODS
This study employed a retrospective cohort study design using the Truven Healthcare and Claims Dataset from 2009-2012. Index date was defined as the first eGFR value during a continuous enrollment period of 24 months. Cohorts of patients were stratified by Kidney Disease: Improving Global Outcomes CKD stage based on eGFR (stages 1: ≥90 mL/min/1.73 m2; 2: 60-89; 3A: 45-59; 3B: 30-44; 4: 15-29; 5: <15). Healthcare expenditures (total patient and payer paid claims) and utilization (number of claims or visits) were estimated 12-months post-index date using generalized linear modeling and negative binomial modeling, respectively, after adjusting for baseline characteristics.


RESULTS
Of 130,098 patients with an index eGFR value and 24-months continuous enrolment, 64,521 (49.59%) were in stage 1 CKD, 47,816 (36.75%) were in stage 2, 13,377 (10.28%) were in stage 3A, 3,217 (2.47%) were in stage 3B, 898 (0.69%) were in stage 4, and 269 (0.21%) were in stage 5. Patients in stages 3A, 3B, and 4 CKD had 1.32 (95% CI = 1.22-1.43), 1.59 (95% CI = 1.41-1.80), and 2.65 (95% CI = 2.23-3.14) times higher rates of diabetes-associated inpatient visits, respectively, compared with stage 1 CKD patients. Patients in stages 3A, 3B, and 4 CKD had increased incremental total annual healthcare expenditures of $1,732 (95% CI = $1,109-$2,356), $2,632 (95% CI = $1,647-$3,619), and $6,949 (95% CI = $5,466-$8,432), respectively, compared with stage 1 CKD patients.


LIMITATIONS
The claims data were generated for billing and reimbursement, not for research purposes.


CONCLUSIONS
These real-world data suggest an incremental and significant increase in economic burden in diabetes as kidney function declines, starting with moderate (stage 3A) CKD.
['McQueen|R Brett|RB|', 'Farahbakhshian|Sepehr|S|', 'Bell|Kelly F|KF|', 'Nair|Kavita V|KV|', 'Saseen|Joseph J|JJ|']
D000367:Age Factors D000368:Aged D003920:Diabetes Mellitus D005260:Female D005919:Glomerular Filtration Rate D006442:Glycated Hemoglobin A D005102:Health Expenditures D006801:Humans D007345:Insurance Claim Review D008297:Male D008875:Middle Aged D017059:Models, Econometric D051436:Renal Insufficiency, Chronic D012189:Retrospective Studies D012720:Severity of Illness Index D012737:Sex Factors D012959:Socioeconomic Factors
Economic burden chronic kidney disease diabetes