Costs and Healthcare Resource Use Associated with Risk of Cardiovascular Morbidity in Patients with Chronic Kidney Disease: Evidence from a Systematic Literature Review

Abstract

Introduction The management of chronic kidney disease (CKD) costs in excess of $114 billion in the USA and £1.45 billion in the UK annually and is projected to increase alongside the increasing disease prevalence. The aim of this review was to evaluate the risks of cardiovascular (CV) morbidity, CV mortality or all-cause mortality based on KDIGO (Kidney Disease: Improving Global Outcomes) 2012 categorisations and estimate the additional costs and healthcare resource utilisation associated with CV morbidity linked to CKD severity in US and UK settings. Methods A systematic literature review was conducted of studies reporting on the risk of CV morbidity, CV mortality or all-cause mortality characterised by CKD severity (published between January 2000 and September 2018). Additional costs and bed days associated with CKD severity in the USA and UK were estimated on the basis of median hazard ratios for CV morbidity risk at each CKD and albuminuria stage. Results Twenty-nine studies reported risk of adverse clinical outcomes based on KDIGO categorisations. Compared to stage 1 (or without) CKD, patients with stage 5 CKD and macroalbuminuria experienced a relative risk increase of 11.77–12.46 across all outcomes. Additional costs and bed days associated with stage 5 CKD and macroalbuminuria (versus stage 1 (or without) CKD) per 1000 patient years were US$3.93 million and 803 bed days and £435,000 and 1017 bed days, in the USA and UK, respectively. Conclusion Risks of adverse clinical outcomes increase with CKD and albuminuria severity and are associated with substantial additional costs and resource utilisation. Thus, early diagnosis and proactive management of CKD and its complications should be a priority for healthcare providers to alleviate the burden of CV morbidity and its management on healthcare resources. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-020-01607-4.

Costs and healthcare utilisation of patients with chronic kidney disease in Spain

“…Different studies have shown that health care costs increase as renal function worsens or albuminuria develops, particularly in patients that finally require kidney replacement therapy [ 5 , 11 – 14 , 16 , 20 , 44 – 46 ]. As a result, although renal replacement therapy has been the object of constant analysis in order to improve the efficiency and sustainability, the fact is that preventing the occurrence and progression of CKD is the best way to reduce health care resource consumption and health care costs.…”

“…As a result, although renal replacement therapy has been the object of constant analysis in order to improve the efficiency and sustainability, the fact is that preventing the occurrence and progression of CKD is the best way to reduce health care resource consumption and health care costs. Therefore, interventions designed to minimize decline in progressive kidney function, particularly among patients with stage 3 or 4 CKD, may reduce the economic CKD burden [ 5 , 11 – 14 , 16 , 20 , 44 – 47 ]. It has been reported that the addition of RAAS inhibitors to prevent the advance of nephropathy is worthwhile not only from a clinical perspective, but also from an economic point of view, even in patients with end stage renal disease, mainly driven by a reduction of hospitalization costs [ 47 , 48 ].…”

“…In addition, CKD promotes the development of end-stage renal disease [ 2 , 4 ]. Remarkably, the risk of adverse outcomes increases as renal function decreases or albuminuria develops [ 5 ].…”

“…Of note, CKD represents a major and growing economic problem [ 3 , 11 , 12 ]. Increasing the knowledge about CKD-related costs is mandatory to ascertain how CKD management can be improved, leading to a significant decrease in CKD burden [ 5 , 11 – 18 ]. Unfortunately, data about the impact of CKD on health care costs in Spain are scarce, and most importantly, not focused on a comprehensive approach [ 19 , 20 ].…”

CHA₂DS₂-VASc Score as a Predictor of Cardiovascular and All-Cause Mortality in Chronic Kidney Disease Patients

“…CKD patients suffer from excess cardiovascular and all-cause mortality [2, 3]. Recognition of high-risk patients could lead to a different approach, treatment, better outcome, and lower health-care cost [4, 5].…”