Examination of Resource Use and Clinical Interventions Associated With Chronic Kidney Disease in a Managed Care Population

Abstract

BACKGROUND: The management of chronic kidney disease (CKD) is multifaceted, including monitoring, early diagnosis, and treatment of comorbidities such as diabetes, hypoalbuminemia, and anemia, and initiating timely procedures in preparation for dialysis such as vascular access placement. Presumably, optimal care provided to patients during the predialysis phase will produce a significant impact on morbidity and mortality outcomes.OBJECTIVE: A retrospective analysis was conducted to assess specific factors that may be associated with optimal quality of care for CKD patients during the predialysis phase.METHODS: Health care resource utilization and the occurrence of interventions associated with optimal predialysis care were evaluated with claims data. Predialysis erythropoietin (EPO) therapy, nephrology referrals, and nutritional supplement administration were all examined during the 12 months prior to dialysis.RESULTS: Medical and pharmacy claims from a managed care database were analyzed for 1,936 incident dialysis patients. Of these, 48.7% did not have any interventions associated with optimal care. Only a minority of patients received prescription iron preparations (6.8%), vitamin D (4.0%), and phosphate binders (7.7%). A total of 20.8% patients had a vascular access placement, and 29.8% were in the care of a nephrologist during this same time period. Only 10.5% received predialysis EPO, yet more than 40% were diagnosed with anemia. Of the EPO users, however, 72.4% were also receiving other interventions to appropriately manage CKD.CONCLUSION: These claims-documented results suggest that the lack of EPO use in predialysis patients in a managed care plan may predict overall suboptimal treatment of these patients. There is an apparent need for the proactive management of CKD in a managed care plan to potentially redistribute or reduce health care resource utilization while improving patient outcomes.

Healthcare Expenditure and Resource Utilization in Patients with Anaemia and Chronic Kidney Disease: A Retrospective Claims Database Analysis

“…More than half of the anaemic patients (59%) received some type of treatment for anaemia. The low rates of anaemia treatment in the clinical setting that we observed are consistent with results from various surveys showing undertreatment or suboptimal treatment of anaemia in patients with CKD [32][33][34][35][36] .…”

Risks of Subsequent Hospitalization and Death in Patients with Kidney Disease

“…Importantly, patients with medication discrepancies are more likely to be readmitted (19). In addition, established practices for kidney disease management are vastly underused (20)(21)(22)(23). A recent survey of internal medicine residents found deficits in almost every domain of knowledge about CKD complications and management (24).…”

Secondary Hyperparathyroidism Is Associated with Higher Cost of Care among Chronic Kidney Disease Patients with Cardiovascular Comorbidities

“…However, on evaluation of USRDS data, the difference between all-cause hospitalization rates and hospital days amongst ESRD patients aged 75 or older (2.142 admissions/PYAR, and 15.9 days/PYAR), and patients aged 65–74 (1.973 admissions/PYAR and 15.0 days/PYAR) was only 0.169 admissions/PYAR and 0.9 days/PYAR, respectively [2]. Although comparative data on hospitalization rates in patients with earlier stages of CKD among various age groups were not available for evaluation, in a study of pre-dialysis patients 67% of the patients with a mean age of 67 years were reported to be hospitalized during the 12-month period leading to dialysis [21], thus confirming a higher hospitalization rate in this population. The DRG Handbook is drawn from a large population and is a good approximation for total hospitalization costs, but it does not make a designation for patients with comorbidities.…”