This study analyzed the prevalence, costs and economic impact of chronic kidney disease CKD in patients with T2D in a Spanish Health District using real-world data. Observational cross-sectional study in adult patients with T2D was through data extracted from the information systems of the Valencia Clínico–La Malvarrosa Health District in the year 2015. Patients were stratified with the KDIGO classification for CKD. Additionally, patients were assigned to Clinical Risk Groups (CRGs) according to multimorbidity. Direct costs of primary and specialized care, and medication were estimated. The prevalence of T2D in the database population (n = 28,345) was 10.8% (mean age (SD) = 67.8 years (13.9); 51.5% male). Up to 14.935 patients (52.6%) had data on kidney function. According to the KDIGO classification, 66.2% of the patients were at low risk of CKD, 20.6% at moderately increased risk, 7.9% at high risk, and 5.2% at very high risk. The average healthcare costs associated with these four risk groups were EUR 3437, EUR 4936, EUR 5899 and EUR 7389, respectively. The large number of T2D patients with CKD in the early stages of the disease generated a significant increase in direct healthcare costs. The economic impact could be mitigated by early and comprehensive therapeutic approaches.

The aim of this work is to analyse recipient and graft survival after kidney transplant in a three-year cohort and to identify predictive factors with up to 10 years of follow-up. Methods: retrospective consecutive cohort study of 250 kidney transplant recipients operated between 2010 and 2012. Multiorganic transplants and both dead-donor and living-donor transplants were included. Data were collected from electronic health records. A survival analysis was conducted using the Kaplan-Meier method and a Cox proportional-hazards multivariate model. Results: mean follow-up was 8.1 ± 3.2 years. Graft survival at 2, 5 and 10 years was 89.0%, 85.1% and 78.4% respectively. The multivariate model identified the following risk factors for graft loss: diabetic nephropathy (HR 3.2 CI95% [1.1–9.4]), delayed graft function (3.8 [2.0–7.4]), chronic kidney rejection (3.7 [1.2–11.4]), and early surgical complications (2.6 [1.4–5.1]). Conversely, combined transplant was found to be a protective factor for graft loss (0.1 [0.0–0.5]). Recipient patient survival was 94.3%, 90.0% and 76.6% at 2, 5 and 10 years respectively. The model identified the following mortality risk factors: older recipient age (1.1 [1.1–1.2]), combined transplant (7.6 [1.7–34.5]) and opportunistic infections (2.6 [1.3–5.0]). Conclusions: 10-year recipient and graft survival were 76.6% and 78.4% respectively. Main mortality risk factors were older recipient age, opportunistic infections and multiorganic transplant. Main graft loss risk factors were diabetic nephropathy, delayed graft function, chronic kidney rejection and early surgical complications.

Objectives: The Europe-based, prospective, observational ReFLeCT study recently showed that switching to the ultralong-acting basal insulin analogue degludec (IDeg) was associated with improved glycemic control and reductions in hypoglycemic events versus previous basal insulin therapies in patients with type 1 (T1D) or type 2 diabetes (T2D). The present analysis aimed to assess the impact of these findings on long-term cost-effectiveness outcomes in the Swedish setting. Methods: Costeffectiveness was evaluated separately in patients with T1D and T2D over a 50-year time horizon using the IQVIA CORE Diabetes Model (version 9.0). Patients were assumed to receive IDeg or continue previous insulin therapy (with or without bolus insulin) for 5 years, before all patients intensified to insulin degludec plus bolus insulin for the remainder of their lifetimes. Baseline cohort characteristics were sourced from ReFLeCT where possible. Treatment effects on initiation of IDeg were based on data from ReFLeCT. Costs were estimated from a Swedish societal perspective and expressed in 2018 Swedish krona (SEK). Results: IDeg was associated with improvements in quality-adjusted life expectancy of 0.14 and 0.07 qualityadjusted life years versus continuation of previous insulin therapy in patients with T1D and T2D, respectively, resulting from improved glycemic control and fewer hypoglycemic events. Combined direct and indirect costs were estimated to be SEK 137,020 and SEK 2,009 lower for insulin degludec versus previous insulin therapy in patients with T1D and T2D, respectively, with higher treatment costs offset by cost savings from avoidance of diabetes-related complications. IDeg was therefore considered dominant versus continuation of previous insulin therapies for the treatment of both T1D and T2D. Conclusions: Based on real-world evidence, IDeg represents an effective and cost-saving treatment option versus other basal insulin therapies for patients with T1D and T2D in Sweden.

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