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Kidney Week

Abstract: PO0500

Understanding Patterns of Medical Spend Informs Design of Upstream Intervention in CKD

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention


  • Srinivas, Titte, University Hospitals, Cleveland, Ohio, United States

Despite ease of diagnosis based on laboratory testing, CKD is often unrecognized and comorbid decompensation results in delayed diagnosis in acute care settings. The purpose of our inquiry was to inform the design of systems of care that would prevent escalation of total cost of care (TCOC) of CKD through minimization of acute care spend.


Unrecognized CKD was defined as CKD that was evident by laboratory data in the EHR but not captured by an ICD10 code or DRG for chronic kidney disease. Recognized CKD or ESRD had both ICD10 and DRG data and laboratory evidence of CKD. We then compared inpatient and total medical spends as well as the density of preventive measures such as wellness visits among these groups. The data respository was built on the MS Power BI platform and machine learning and high throughput analyses were conducted using Alteryx utilities.


A total of 217,125 patients were included that had eGFR and spend data in 2019. Annual wellness visits occurred on average among 38 percent (n=142,373) of those with no CKD diagnosed or evident by lab values vs. 19.1 percent of those with unrecognized Stage 3b to 4 CKD (n=31,435) vs. 18 percent among those with recognized Stage 3-5 CKD or ESRD (n= 52,242; P < 0.001). No statistical difference was observed between wellness rates and stage 1 and stage 2 unrecognized CKD cohorts. Of annual spend in 2019, those with recognized CKD/ESRD, incurred 61.9 percent of spend in the inpatient setting vs. 25 percent among those with unrecognized CKD. The number of chronic condition increased from an average of 3.5 among those with Stage 3-5 unrecognized CKD to 10 among those with recognized CKD/ESRD. Average 12 mo spend was $ 6500 among those with unrecognized CKD stage 3b-5 and $ 22,978 among those with recognized CKD/ESRD (p<.0001). A diagnosis of CHF was recorded in 13.1 %, 20.5 %, and 24.3 % of those with undiagnosed CKD stage 3a-5 vs. 46.9 percent of those with diagnosed CKD/ESRD (Chi square for trend <0.001).


CKD is often unrecognized clinically despite eGFR support of its existence in the medical record
Decompensation of unrecognized heart disease likely contributes to increased inpatient utilization and costs with clinical recognition of CKD
Wellness measures are unfortunately deficient in this population and systems of care triggered by eGFR values could inform care upstream of CKD decompensation to capture value.


  • Clinical Revenue Support