title: Effect of chronic kidney disease and comorbid conditions on health care costs: A 10-year observational study in a general population.
abstract: BACKGROUND
  Chronic kidney disease (CKD) is common, but the longitudinal effects of CKD and associated comorbidities on health care costs in the general population are unknown.
  
  
  METHODS
  Population-based cohort study of 2,988 subjects in Germany, aged 25-74 years at baseline, who participated both in the baseline and 10-year follow-up examination (1994/95-2004/05). Presence of CKD was based on serum creatinine and defined as an estimated glomerular filtration rate of <60 ml/min/1.73 m(2). Self-reported health services utilization was used to estimate costs.
  
  
  RESULTS
  Health care costs at baseline and follow-up were higher for subjects with CKD. Controlling for socio-economics, lifestyle factors and comorbid conditions, subjects with baseline CKD, in comparison to those without, exhibited 65% higher total costs 10 years after baseline examination, corresponding to a difference in adjusted costs of EUR 743. Incident CKD was related to 38% higher total costs. Costs for inpatient treatment and drug costs were the major costs components, while CKD revealed no effect on outpatient costs. The effect of CKD was strongly modified by angina, myocardial infarction, diabetes, and anemia.
  
  
  CONCLUSIONS
  The direct effect of CKD on costs is modified by comorbid conditions. Therefore, early treatment of CKD and its precipitous factors may save future health care costs.
authors.affiliation: Institute of Epidemiology, Helmholtz Zentrum Munchen, German Research Center for Environmental Health, Munich, Germany. sebastian.baumeister@uni-greifswald.de
authors.forename: Sebastian E
authors.initials: SE
authors.lastname: Baumeister
authors.forename: Carsten A
authors.initials: CA
authors.lastname: Böger
authors.forename: Bernhard K
authors.initials: BK
authors.lastname: Krämer
authors.forename: Angela
authors.initials: A
authors.lastname: Döring
authors.forename: Dirk
authors.initials: D
authors.lastname: Eheberg
authors.forename: Beate
authors.initials: B
authors.lastname: Fischer
authors.forename: Jürgen
authors.initials: J
authors.lastname: John
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Koenig
authors.forename: Christa
authors.initials: C
authors.lastname: Meisinger
mesh_terms: D000328:Adult; D000368:Aged; D000581:Amidohydrolases / Q000097:blood; D015897:Comorbidity; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D005919:Glomerular Filtration Rate; D017048:Health Care Costs / Q000706:statistics & numerical data*; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D010045:Outpatients / Q000706:statistics & numerical data; D051436:Renal Insufficiency, Chronic / Q000191:economics* / Q000453:epidemiology*
chemical_list: D000581:Amidohydrolases; C019946:creatininase