Identifying chronic kidney disease stage 3 with excess disease burden.

Publisher: Clinical Care Targeted Communications Group, LLC Country of Publication: United States NLM ID: 9613960 Publication Model: Electronic Cited Medium: Internet ISSN: 1936-2692 (Electronic) Linking ISSN: 10880224 NLM ISO Abbreviation: Am J Manag Care Subsets: MEDLINE

Publication: Cranbury, NJ : Clinical Care Targeted Communications Group, LLC
Original Publication: Old Bridge, NJ : American Medical Pub., c1995-

Renal Insufficiency, Chronic*/epidemiology ; Renal Insufficiency, Chronic*/economics ; Medicare*/statistics & numerical data ; Medicare*/economics ; Disease Progression*; Humans ; Retrospective Studies ; Male ; United States ; Female ; Aged ; Comorbidity ; Cost of Illness ; Fee-for-Service Plans ; Aged, 80 and over ; Severity of Illness Index ; Kidney Failure, Chronic/epidemiology ; Kidney Failure, Chronic/economics ; Referral and Consultation/statistics & numerical data

Objectives: Chronic kidney disease (CKD) is a widely prevalent disease with heterogeneous disease progression. Prior study findings suggest that early referral to nephrologists can improve health outcomes for patients with CKD. Current practice guidelines recommend nephrology referral when patients are diagnosed with CKD stage 4. We tested whether a subset of patients with CKD stage 3 and common medical comorbidities demonstrates disease progression, cost, and utilization patterns that would merit earlier referral.
Study Design: Retrospective study of Medicare fee-for-service beneficiaries with CKD stages 3 through 5 and end-stage kidney disease.
Methods: We identified 7 comorbidities with high prevalence in patients with progressive CKD and segmented beneficiaries with CKD stage 3 based on the presence of these comorbidities. Outcomes including costs, utilization, and disease progression were then compared across beneficiaries with different stages of CKD.
Results: We identified that beneficiaries with CKD stage 3 and at least 1 of the selected comorbidities (CKD stage 3-plus) represented 35.4% of all beneficiaries with CKD stage 3. The CKD stage 3-plus cohort had cost and utilization patterns that were more similar to beneficiaries with CKD stages 4 and 5 than to beneficiaries with CKD stage 3 without the selected comorbidities.
Conclusions: Our findings demonstrate the use of a claims-based algorithm to identify patients with CKD stage 3 who have high costs and are at risk of disease progression, highlighting a potential subset of patients who might benefit from earlier nephrology intervention.

Date Created: 20240624 Date Completed: 20240624 Latest Revision: 20240809

20240809

10.37765/ajmc.2024.89564

38912931