Impact of Proteinuria and Kidney Function Decline on Health Care Costs and Resource Utilization in Adults With IgA Nephropathy in the United States: A Retrospective Analysis

Lerma, Edgar V.; Bensink, Mark; Thakker, Kamlesh M.; Lieblich, Richard; Bunke, Martin; Rava, Andrew; Wang, Kaijun; Murphy, Michael V.; Oliveri, David; Amari, Diana T.; Cork, David M W

doi:10.1016/j.xkme.2023.100693

Cited by 4 publications

(4 citation statements)

References 18 publications

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“…The rate of CVD events per 100 person-years was high in patients with elevated baseline proteinuria ($1 g/d) and for patients with KF at baseline (Supplemental Table 3). Combined, these results align with previous research on the economic burden associated with IgAN 22 and provide additional insight into the role CVD-related events may play. Our results must be considered in the context of potential limitations associated with using secondary data sources.…”

Section: Discussionsupporting

confidence: 87%

“…[19][20][21] In our initial investigation into the burden associated with IgAN, we identified that healthcare resource utilization and costs were higher for patients with high-risk proteinuria ($1 g/d; observed in 54% of the overall and 55% of the adult population at baseline, respectively) and worsening kidney function. 22 The aim of this study was to evaluate the prognostic effects of proteinuria on the outcome of CVD/all-cause mortality and KF/all-cause mortality using a US real-world data source. In addition, we evaluated the relationship between progression to KF and occurrence of CVD/mortality events.…”

Section: Introductionmentioning

confidence: 99%

“… 19 – 21 In our initial investigation into the burden associated with IgAN, we identified that healthcare resource utilization and costs were higher for patients with high-risk proteinuria (≥1 g/d; observed in 54% of the overall and 55% of the adult population at baseline, respectively) and worsening kidney function. 22 …”

Section: Introductionmentioning

confidence: 99%

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Kidney Failure Events, Cardiovascular Disease Events, and All-Cause Mortality in Patients with IgA Nephropathy in a Real-World Database

Lerma,

Thakker,

Bensink

et al. 2024

Kidney360

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Background: IgA nephropathy (IgAN) associated glomerular injury leads to proteinuria, hematuria, and progressive loss of glomerular filtration rate, with progression to kidney failure (KF). This retrospective study evaluated the prognostic effects of proteinuria and progression to KF on cardiovascular disease (CVD)/mortality events and KF/mortality events in the United States. Methods: We conducted a non-interventional, retrospective cohort study in adult IgAN patients using Optum’s de-identified Market Clarity Data (01/01/2007 to 03/31/2021). Adult (≥18 years old) patients with at least two signs, disease, symptoms natural language processing term entries for IgAN, within 180 days and ≥30 days apart within the identification period were included. Outcomes were assessed by time-dependent proteinuria (≥1 g/day vs. <1 g/day) and KF status (pre vs. post). Descriptive statistics were used for categorical and continuous variables. Multivariable Cox proportional hazard models with time-dependent predictors were used to estimate differences across groups. Results: Pre-KF patients with proteinuria ≥1 g/day were more likely to have a CVD/mortality event during follow-up (adjusted hazard ratio [HR; 95% CI]: 1.80 [1.12–2.89]; p<0.001) or a KF/mortality event (adjusted HR [95% CI]: 2.10 [1.73–2.56]; p<0.001). Post-KF patients were more likely to have a CVD/mortality event during follow-up (adjusted HR [95% CI]: 3.28 [2.82–3.81]; p<0.001). Conclusions: Elevated proteinuria and progression to KF was associated with higher risk of CVD/mortality events. Elevated pre-KF proteinuria was also associated with progression to KF/mortality events. Based on our real-world retrospective database analysis, we hypothesize that novel IgAN therapies that reduce proteinuria and slow the rate of progression to KF have the potential to reduce CVD risk, improve kidney outcomes and prolong/increase overall survival.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

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Kidney Failure Events, Cardiovascular Disease Events, and All-Cause Mortality in Patients with IgA Nephropathy in a Real-World Database

Lerma,

Thakker,

Bensink

et al. 2024

Kidney360

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“…Using the signs, diseases, and symptoms file, which includes structured data elements derived from clinical notes using NLP, we searched for symptom terms from nine categories recorded across every 1-week interval in the 6 months before and 6 months after dialysis initiation. Optum developed an NLP approach 12 that identified a list of .17,000 unique signs, diseases, and symptom terms contained within clinician notes in the EHR. Two nephrologists (J.B.W.…”

Section: Assessment Of Symptomsmentioning

confidence: 99%

Symptom Trajectories in the Electronic Health Record during the Transition to Maintenance Dialysis

Wetmore,

Johansen,

Gilbertson

et al. 2023

CJASN

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How symptoms recorded in the electronic health record (EHR) change during the transition to dialysis has not been fully explored. We used the Optum® de-identified Integrated Claims-Clinical Dataset to identify individuals with CKD stages 4 or 5 who transitioned to dialysis. We searched structured data elements from clinical notes, identified by natural language processing, for symptoms recorded across weekly intervals in the 6 months before and after dialysis initiation and estimated changes in the odds of a symptom being recorded with an interrupted time series analysis using segmented logistic regression. The cohort comprised 728 individuals (aged 67.7 ± 13.1 years, 44% women, 56% White, 30% Black). Prior to dialysis initiation, 83% were recorded as having pain, 68% fatigue/weakness, 66% shortness of breath, 61% nausea/vomiting, and 37% difficulty concentrating. Before dialysis initiation, odds of pain being recorded increased (slope: OR 1.02 per week, 95% CI 1.01 – 1.03); initiation was associated with a decrease (intercept change: OR 0.70, 95% CI 0.59 – 0.82). After initiation, odds of pain were unchanged (post-dialysis slope: OR 1.00 per week, 95% CI 0.99 – 1.01), although this represented an improved trajectory relative to the pre-dialysis period (change in slope: OR 0.98 per week, 95% CI 0.96 – 0.99). For fatigue/weakness, odds increased before initiation (OR 1.03 per week, 95% CI 1.02 – 1.04) but decreased upon initiation (OR 0.62, 95% CI 0.51 – 0.75) and thereafter (OR 0.98 per week, 95% 0.97 – 0.99), representing a reduction in slope (OR 0.95 per week, 95% CI 0.94 – 0.97). Patterns for shortness of breath, nausea/vomiting, and difficulty concentrating were similar to those of pain. Thus, the odds of five key symptoms being recorded in the EHR increased over time in the 6 months prior to dialysis initiation, decreased immediately upon initiation, and, generally, remained unchanged in the 6 months thereafter.

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Cost-effectiveness analysis of atezolizumab plus bevacizumab and chemotherapy for the treatment of metastatic, persistent, or recurrent cervical cancer (BEATcc)

Zhu,

Shi,

Lin

et al. 2024

Expert Review of Pharmacoeconomics & Outcomes Research

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Impact of Proteinuria and Kidney Function Decline on Health Care Costs and Resource Utilization in Adults With IgA Nephropathy in the United States: A Retrospective Analysis

Cited by 4 publications

References 18 publications

Kidney Failure Events, Cardiovascular Disease Events, and All-Cause Mortality in Patients with IgA Nephropathy in a Real-World Database

Kidney Failure Events, Cardiovascular Disease Events, and All-Cause Mortality in Patients with IgA Nephropathy in a Real-World Database

Symptom Trajectories in the Electronic Health Record during the Transition to Maintenance Dialysis

Cost-effectiveness analysis of atezolizumab plus bevacizumab and chemotherapy for the treatment of metastatic, persistent, or recurrent cervical cancer (BEATcc)

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