Clinical and economic burden of chronic kidney disease in Medicare Fee-for-Service beneficiaries with and without comorbid type 2 diabetes and heart failure: A retrospective cohort study.

Abstract

Chronic kidney disease (CKD) is common in older adults and is often associated with type 2 diabetes (T2DM) and heart failure (HF). However, little is known about the burden of newly diagnosed CKD in Medicare Fee-for-Service (FFS) beneficiaries, including those with comorbid T2DM or HF. To quantify the clinical and economic burden of CKD in Medicare FFS beneficiaries, including those with comorbid T2DM or HF. In this retrospective cohort study using 100% Medicare FFS claims data (Parts A, B, D) from 2014 to 2022, beneficiaries with incident CKD (based on a diagnosis code on 2 distinct dates) from January 1, 2015, to December 31, 2021, were included; index date was the date of earliest CKD diagnosis. Beneficiaries with a diagnosis of CKD, acute kidney injury, dialysis, kidney transplantation, or a claim for any condition other than T2DM that could cause kidney disease during a 365-day baseline period prior to index date were excluded. Beneficiaries with CKD were categorized into 4 mutually exclusive cohorts: CKD-only; CKD+HF; CKD+T2DM; and CKD+HF+T2DM based on claims during the baseline period. Clinical burden was measured as prevalence at baseline and incidence of key clinical outcomes at 12 months of follow-up. Economic burden was measured as all-cause and CKD-related health care resource utilization (HCRU) and inflation-adjusted costs in the baseline period and at 12 months of follow-up. The overall cohort consisted of 2,260,075 patients, mean (SD) age 78.3 (7.7) years (56.5% CKD-only; 7.2% CKD+HF; 30.9% CKD+T2DM; and 5.4% CKD+HF+T2DM). The CKD+HF+T2DM cohort generally exhibited the highest incidence of clinical outcomes within 12 months. Cohorts with HF had higher HCRU across all claim types in both the baseline and 12-month follow-up periods compared with the other cohorts (<i>P</i> < 0.001 for comparison across cohorts). All-cause total costs at 12 months were numerically highest for the cohorts defined by the presence of HF (CKD+HF, mean [SD] $47,668 [$53,978]; CKD+HF+T2DM, mean [SD] $54,477 [$57,430] compared with the other cohorts (CKD-only, mean [SD] $24,180 [$37,623]; CKD+T2DM, $29,602 [$40,963]) (<i>P</i> < 0.001 for comparison across cohorts). Relative spending across cohorts was similar for CKD-related total costs at 12 months. Older adults with a new diagnosis of CKD experienced considerable clinical and economic burden, and presence of T2DM and HF was associated with larger burden. All-cause mean total costs at 12 months after a new diagnosis of CKD ranged from $24,180 for the CKD-only cohort to $54,477 for the CKD+HF+T2DM cohort.