Projection of the health and economic impacts of Chronic kidney disease in the Chilean population

Abstract

Background Chronic Kidney Disease (CKD) is a leading public health problem, with substantial burden and economic implications for healthcare systems, mainly due to renal replacement treatment (RRT) for end-stage kidney disease (ESKD). The aim of this study is to develop a multistate predictive model to estimate the future burden of CKD in Chile, given the high and rising RRT rates, population ageing, and prevalence of comorbidities contributing to CKD. Methods A dynamic stock and flow model was developed to simulate CKD progression in the Chilean population aged 40 years and older, up to the year 2041, adopting the perspective of the Chilean public healthcare system. The model included six states replicating progression of CKD, which was assumed in 1-year cycles and was categorised as slow, medium or fast progression, based on the underlying conditions. We simulated two different treatment scenarios. Only direct costs of treatment were included, and a 3% per year discount rate was applied after the first year. We calibrated the model based on international evidence; the exploration of uncertainty (95% credibility intervals) was undertaken with probabilistic sensitivity analysis. Results By the year 2041, there is an expected increase in cases of CKD stages 3a to ESKD, ceteris paribus, from 442,265 (95% UI 441,808–442,722) in 2021 to 735,513 (734,455–736,570) individuals. Direct costs of CKD stages 3a to ESKD would rise from 322.4M GBP (321.7–323.1) in 2021 to 1,038.6M GBP (1,035.5–1,041.8) in 2041. A reduction in the progression rates of the disease by the inclusion of SGLT2 inhibitors and pre-dialysis treatment would decrease the number of individuals worsening to stages 5 and ESKD, thus reducing the total costs of CKD by 214.6M GBP in 2041 to 824.0M GBP (822.7–825.3). Conclusions This model can be a useful tool for healthcare planning, with development of preventive or treatment plans to reduce and delay the progression of the disease and thus the anticipated increase in the healthcare costs of CKD.

ARIMA model for predicting chronic kidney disease and estimating its economic burden in China

“…In a study from Singapore, the Markov model was used to predict the prevalence and number of residents with CKD, and the results indicated that from 2007 to 2035, the number of residents with CKD was expected to increase from 316,521 to 887,870, and the prevalence would increase from 12.2 to 24.3% [51]. A study developed a dynamic stock and flow model to project the future burden of CKD in Chile showed that both the number of cases and direct economic burden of CKD would increase from 2021 to 2041 [52]. The results of the above studies are consistent with this study, indicating that CKD has become one of the important public health problems worldwide.…”

HbA1c as Early Warning Complications of Kidney Failure in Type 2 Diabetes Mellitus

“…Furthermore, HbA1c may be a link between chronic hyperglycemia and oxidative stress, and endothelial dysfunction. HbA1c is a target for intracellular glycoxidation and peroxidation reactions that result in the formation of advanced glycation end products (Bakris et [13], [14], [15], [16], [17], which are involved in the initiation and progression of atherosclerosis. Finally, changes in glycemia can induce growth factor activation, which may contribute to the development of intraglomerular hypertension in people with pre-diabetes.…”

Towards the Future of Public Health: Roadmapping Trends and Scenarios in the Post-COVID Healthcare Era

“…The change in the pattern of diseases, with a more accentuated burden in chronic conditions such as cardiovascular disease and kidney disease, as well as conditions related to mental illness, such as depression, schizophrenia, anxiety disorders, and others, will bring even greater challenges to the health sector [52,53,55]. Aging in the future will take place in a context very different from what we have experienced so far.…”

“…An increase in the number of older people brings new health challenges for the public and private health sectors, mainly due to the association between population aging and the rise in demand for specialized and high-quality cost assistance [30,55]. This demand increase is primarily due to the increase, over the years, in the risk of developing chronic diseases or disabilities caused by advanced age [52].…”