Kidney Failure Risk Equation and Cost of Care in Patients with Chronic Kidney Disease

Abstract

Background and objectivesPatients with CKD exhibit heterogeneity in their rates of progression to kidney failure. The kidney failure risk equation (KFRE) has been shown to accurately estimate progression to kidney failure in adults with CKD. Our objective was to determine health care utilization patterns of patients on the basis of their risk of progression.Design, setting, participants, & measurementsWe conducted a retrospective cohort study of adults with CKD and eGFR of 15–59 ml/min per 1.73 m2 enrolled in multidisciplinary CKD clinics in the province of Saskatchewan, Canada. Data were collected from January 1, 2004 to December 31, 2012 and followed for 5 years (December 31, 2017). We stratified patients by eGFR and risk of progression and compared the number and cost of hospital admissions, physician visits, and prescription drugs.ResultsIn total, 1003 adults were included in the study. Within the eGFR of 15–29 ml/min per 1.73 m2 group, the costs of hospital admissions, physician visits, and drug dispensations over the 5-year study period comparing high-risk patients with low-risk patients were (Canadian dollars) $89,265 versus $48,374 (P=0.008), $23,423 versus $11,231 (P<0.001), and $21,853 versus $16,757 (P=0.01), respectively. Within the eGFR of 30–59 ml/min per 1.73 m2 group, the costs of hospital admissions, physician visits, and prescription drugs were $55,944 versus $36,740 (P=0.10), $13,414 versus $10,370 (P=0.08), and $20,394 versus $14,902 (P=0.02) in high-risk patients in comparison with low-risk patients, respectively, for progression to kidney failure.ConclusionsIn patients with CKD and eGFR of 15–59 ml/min per 1.73 m2 followed in multidisciplinary clinics, the costs of hospital admissions, physician visits, and drugs were higher for patients at higher risk of progression to kidney failure by the KFRE compared with patients in the low-risk category. The high-risk group of patients with CKD and eGFR of 15–29 ml/min per 1.73 m2 had stronger association with hospitalizations costs, physician visits, and drug utilizations.

Association of the Kidney Failure Risk Equation With High Health Care Costs

“…In this study of patients with CKD stages G3 and G4, we found that higher risk of progression to kidney failure as calculated by the KFRE was associated with higher monthly all-cause medical costs in a population-based sample of US patients. These findings are consistent with previous Canadian data associating KFRE-based risk to health care costs, 17 and extend these observations to a larger data set in the US health care system. Because nephrology practices integrate the KFRE in their EHRs or clinical decision support software, they can assume that the highest risk individuals as identified by the equation are also likely to have the highest health care costs.…”

“…In a Canadian study, patients classified as high-risk of progression with the KFRE (5-year risk >15%) have been demonstrated to have approximately twice the costs of hospital admissions and physician visits and a 30% increase in drug dispensation expenses over a 5-year period compared with the low-risk group. 17 Risk as determined by the KFRE and its association with costs in the US health care system, as well as a broader general population not referred for nephrology care, have not been studied. Therefore, we aimed to determine the relationship between risk as classified by the KFRE and all-cause medical costs from the perspective of the US health system payer.…”

Machine Learning Models for the Prediction of Renal Failure in Chronic Kidney Disease: A Retrospective Cohort Study

“…Chronic kidney disease (CKD) is a global health problem associated with a high risk of adverse clinical events and high health care costs [ 1 ]. In addition, CKD progression can induce the development of cardiovascular disease [ 2 ] and diabetes [ 3 ].…”

Patient Perspectives on Integrating Risk Prediction Into Kidney Care: Opinion Piece

“… 2 , 3 The KFRE ( Figure 1 ) can be used at the bedside to help clinicians accurately stratify patients according to their level of risk of kidney failure, consequently allowing for clinicians to appropriately treat high-risk patients while safely monitoring low-risk patients, and can also be used as a tool to assess health care resource utilization and associated costs. 4 The KFRE is also a valuable resource to guide CKD education and shared decision-making between clinicians and patients, and provides patients with accurate information about their prognosis. In this article, we share the journeys of 3 individuals living with CKD and their reactions to the use of risk prediction equations.…”