CKD Progression and Economic Burden in Individuals With CKD Associated With Type 2 Diabetes

C Daniel Mullins; Kevin M Pantalone; Keith A Betts; Jinlin Song; Aozhou Wu; Yan Chen; Sheldon X Kong; Rakesh Singh

doi:10.1016/j.xkme.2022.100532

CKD Progression and Economic Burden in Individuals With CKD Associated With Type 2 Diabetes

Kidney Med. 2022 Aug 11;4(11):100532. doi: 10.1016/j.xkme.2022.100532. eCollection 2022 Nov.

Authors

C Daniel Mullins¹, Kevin M Pantalone², Keith A Betts³, Jinlin Song³, Aozhou Wu³, Yan Chen³, Sheldon X Kong⁴, Rakesh Singh⁴

Affiliations

¹ University of Maryland Baltimore, Baltimore, MD.
² Department of Endocrinology and Metabolism, Cleveland Clinic, Cleveland, OH.
³ Analysis Group, Inc, Los Angeles, CA.
⁴ Bayer U.S. LLC, Whippany, NJ.

Abstract

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.

Keywords: CKD progression; Type 2 diabetes; chronic kidney disease; healthcare costs; healthcare resource utilization.