Patients with CKD, type 2 diabetes likely to progress to high risk within 5 years
Click Here to Manage Email Alerts
In a 5-year period, 18.9% of patients with chronic kidney disease and type 2 diabetes progressed from moderate or high baseline risk to very high risk.
Further, an impaired urine albumin-to-creatinine ratio (UACR) correlated with faster progression.
“The Kidney Disease: Improving Global Outcomes (KDIGO) clinical guidelines characterize CKD prognostic risk categories using both glomerular filtration rate and UACR,” C. Daniel Mullins, PhD, professor and chair in the department of pharmaceutical health services research at University of Maryland, and colleagues wrote. “Using a U.S. electronic medical records database of patients with type 2 diabetes (T2D), this study assessed the risk of CKD progression in KDIGO risk categories and quantified the economic burden by progression group.”
In a retrospective cohort study, researchers examined 269,187 adults with T2D and moderate to severe CKD in the Optum electronic health care records database between January 2007 and December 2019.
Researchers determined KDIGO risk categories based on patients’ two eGFR measures establishing the same eGFR stage and one UACR measure obtained after at least 1 year of the established eGFR stage. These stages included moderate to high/very high risk and from high to very high risk. Researchers measured health care resource utilization with inpatient admissions, emergency room visits and outpatient visits during the study period.
Using cumulative incidence, researchers calculated progression probability. Additionally, researchers compared health care resource utilization and medical costs across progression groups.
In a 5-year period, researchers observed 18.9% of patients progress to the very high-risk category. Similarly, 17.8% of those with stage G1-A2 CKD, 44% of those with stage G2-A2 and 61.3% of those with stage G3a-A1 CKD patients progressed to a higher KDIGO risk category. Moreover, 63.9% of those with stage G3b-A1/G3a-A2 CKD and 56% of those with stage G2-A3 CKD progressed to very high risk.
A higher UACR stage correlated with a four-to seven-times higher risk of progressing to very high risk and faster eGFR decline. Patients who did not progress experienced $16,924 in annual medical costs compared with the $22,117 for those who progressed from moderate risk to high risk. The annual medical cost rose to $35,092 for those who progressed from moderate risk to very high risk.
“In conclusion, in this retrospective study, patients with T2D and CKD who were in moderate or high KDIGO risk categories at the index date had high probabilities of progression to a higher risk category within 5 years. Moreover, an impaired UACR was associated with faster progression. Patients who progressed to a higher risk category incurred significantly higher health care resource utilization and medical costs compared with those without progression,” Mullins and colleagues wrote. “These results underscore the high clinical and economic burdens associated CKD progression defined using both eGFR and UACR and highlight the value of UACR in CKD management.”
Collapse
Read more about
Click Here to Manage Email Alerts