title: Patient characteristics, disease burden, and medication use in stage 4 - 5 chronic kidney disease patients.
abstract: OBJECTIVE
  We aimed to assess demographic characteristics, comorbidity and hospitalization burdens, laboratory abnormalities, and patterns of chronic kidney disease (CKD)-related medication use in a large cohort of patients with CKD stage 4 - 5.
  
  
  METHODS
  In a retrospective cohort analysis, the Medicare 5% sample and Truven MarketScan employer group health plan databases were used to examine patients aged ≥ 65 and < 65 years, respectively. CKD was determined by ≥ 1 inpatient or ≥ 2 outpatient claims with relevant ICD-9-CM diagnosis codes during the 1-year baseline period. The follow-up period was 1 year from day 91 after the index date
  
  
  RESULTS
  In the Medicare data, 12,930 (1.1%) CKD stage 4 - 5 patients were identified. Mean age was 79.2 ± 7.4 years; 56.1% were women and 83.1% white; 46.8% had atherosclerotic heart disease, and 36.9% congestive heart failure; 37.9% were hospitalized within 1 year. In the MarketScan data, 6,010 (0.04%) patients were identified. Mean age was 55.2 ± 8.8 years; 48.0% were women; 21.4% were hospitalized within 1 year. Heart failure was the leading cause of hospitalization for both groups. Parathyroid hormone levels were > 300 pg/mL for 39.1% of MarketScan patients, but only 20.9% received activated vitamin D. ESAs were administered to 28.2% of MarketScan patients with iron saturation < 30% and to 7.7% with hemoglobin > 11.5% and saturation ≥ 30%.
  
  
  CONCLUSIONS
  Comorbidity burdens and hospitalization rates were high for patients with advanced, non-dialysis requiring CKD. While hyperparathyroidism and anemia were common, appropriate medication use was not optimal, suggesting opportunities for improved care.
authors.forename: James B
authors.initials: JB
authors.lastname: Wetmore
authors.forename: Yi
authors.initials: Y
authors.lastname: Peng
authors.forename: Scott
authors.initials: S
authors.lastname: Jackson
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Matlon
authors.forename: Allan J
authors.initials: AJ
authors.lastname: Collins
authors.forename: David T
authors.initials: DT
authors.lastname: Gilbertson
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D006961:Hyperparathyroidism / Q000453:epidemiology; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D006278:Medicare; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000627:therapeutic use; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology*; D012189:Retrospective Studies; D012737:Sex Factors; D014481:United States; D014807:Vitamin D / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D010281:Parathyroid Hormone; D014807:Vitamin D