title: Economic burden of comorbid chronic kidney disease and diabetes.
abstract: OBJECTIVE
  To estimate real-world healthcare utilization and expenditures across the spectrum of chronic kidney disease (CKD), as determined by estimated glomerular filtration rate (eGFR) categories in patients with diabetes.
  
  
  METHODS
  This study employed a retrospective cohort study design using the Truven Healthcare and Claims Dataset from 2009-2012. Index date was defined as the first eGFR value during a continuous enrollment period of 24 months. Cohorts of patients were stratified by Kidney Disease: Improving Global Outcomes CKD stage based on eGFR (stages 1: ≥90 mL/min/1.73 m2; 2: 60-89; 3A: 45-59; 3B: 30-44; 4: 15-29; 5: <15). Healthcare expenditures (total patient and payer paid claims) and utilization (number of claims or visits) were estimated 12-months post-index date using generalized linear modeling and negative binomial modeling, respectively, after adjusting for baseline characteristics.
  
  
  RESULTS
  Of 130,098 patients with an index eGFR value and 24-months continuous enrolment, 64,521 (49.59%) were in stage 1 CKD, 47,816 (36.75%) were in stage 2, 13,377 (10.28%) were in stage 3A, 3,217 (2.47%) were in stage 3B, 898 (0.69%) were in stage 4, and 269 (0.21%) were in stage 5. Patients in stages 3A, 3B, and 4 CKD had 1.32 (95% CI = 1.22-1.43), 1.59 (95% CI = 1.41-1.80), and 2.65 (95% CI = 2.23-3.14) times higher rates of diabetes-associated inpatient visits, respectively, compared with stage 1 CKD patients. Patients in stages 3A, 3B, and 4 CKD had increased incremental total annual healthcare expenditures of $1,732 (95% CI = $1,109-$2,356), $2,632 (95% CI = $1,647-$3,619), and $6,949 (95% CI = $5,466-$8,432), respectively, compared with stage 1 CKD patients.
  
  
  CONCLUSIONS
  The claims data were generated for billing and reimbursement, not for research purposes.
  
  
  CONCLUSIONS
  These real-world data suggest an incremental and significant increase in economic burden in diabetes as kidney function declines, starting with moderate (stage 3A) CKD.
authors.affiliation: a Department of Clinical Pharmacy , University of Colorado Anschutz Medical Campus , Aurora , CO , USA.
authors.forename: R Brett
authors.initials: RB
authors.lastname: McQueen
authors.affiliation: b Employee of AstraZeneca , Wilmington , DE , USA.
authors.forename: Sepehr
authors.initials: S
authors.lastname: Farahbakhshian
authors.affiliation: b Employee of AstraZeneca , Wilmington , DE , USA.
authors.forename: Kelly F
authors.initials: KF
authors.lastname: Bell
authors.affiliation: a Department of Clinical Pharmacy , University of Colorado Anschutz Medical Campus , Aurora , CO , USA.
authors.forename: Kavita V
authors.initials: KV
authors.lastname: Nair
authors.affiliation: a Department of Clinical Pharmacy , University of Colorado Anschutz Medical Campus , Aurora , CO , USA.|c Department of Family Medicine , University of Colorado Anschutz Medical Campus , Aurora , CO , USA.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Saseen
mesh_terms: D000367:Age Factors; D000368:Aged; D003920:Diabetes Mellitus / Q000191:economics* / Q000453:epidemiology*; D005260:Female; D005919:Glomerular Filtration Rate; D006442:Glycated Hemoglobin; D005102:Health Expenditures; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D008875:Middle Aged; D017059:Models, Econometric; D051436:Renal Insufficiency, Chronic / Q000191:economics* / Q000453:epidemiology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012737:Sex Factors; D012959:Socioeconomic Factors
chemical_list: D006442:Glycated Hemoglobin
keywords: Economic burden; chronic kidney disease; diabetes