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Abstract: PO2410

Patterns of Progression of Stage 2 CKD and Associated Costs in Medicare Advantage Enrollees

Session Information

Category: CKD (Non-Dialysis)

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

Authors

  • Diamantidis, Clarissa Jonas, Duke University Department of Medicine, Durham, North Carolina, United States
  • Storfer-Isser, Amy, National Committee for Quality Assurance, Washington, District of Columbia, United States
  • Wang, Virginia, Duke University Department of Population Health Sciences, Durham, North Carolina, United States
  • Zepel, Lindsay, Duke University Department of Population Health Sciences, Durham, North Carolina, United States
  • Scholle, Sarah Hudson, National Committee for Quality Assurance, Washington, District of Columbia, United States
  • Maciejewski, Matthew L., Duke University Department of Population Health Sciences, Durham, North Carolina, United States
Background

The prevalence of chronic kidney disease (CKD) in Medicare beneficiaries has quadrupled in the past two decades. Little is known about patterns of progression in older adults with early CKD. We identify CKD progression trajectories, risk factors and health care costs for these trajectories in a large cohort of Medicare Advantage (MA) enrollees with stage 2 CKD.

Methods

In a cohort of 418,930 MA enrollees, we identified trajectories of stage 2 CKD progression (measured by estimated glomerular filtration rate (eGFR)) from 2014-2018 via group-based trajectory modeling. Multinomial logistic regression was used to identify patient factors associated with each trajectory. Mean total costs one year before and two years after baseline are described.

Results

The cohort had a mean age of 72.6 years, was predominantly female (57.2%) and White (67.8%), with mean baseline eGFR of 75.3 ml/min/1.73m2. Median follow-up was 2.6 years. We identified 5 trajectories of kidney function: stable kidney function (22.1%); slow decline with mean baseline eGFR 78.3 (30.1%), slow decline with mean baseline eGFR 71.0 (28.5%); steep decline (16.4%); accelerated decline (2.9%). In adjusted analyses, higher odds of accelerated decline (vs. stable kidney function) were found in those age 75 and older, (odds ratio (OR)=2.84, 95% confidence interval (CI): 2.38-3.38), living in a non-metropolitan area (OR=1.26, 95% CI: 1.18-1.35), with lower eGFR at baseline (OR=0.64, 95% CI: 0.63-0.64), greater comorbidity (OR=1.28, 95% CI: 1.27-1.29), having a nephrologist visit (OR=2.06, 95% CI: 1.81-2.34) or clinical diagnosis of CKD (OR=4.41, 95% CI: 4.11-4.74) during the year prior to baseline. Mean total MA costs of enrollees with accelerated kidney function decline were nearly twice as high as costs of MA enrollees in the other 4 trajectories in every year ($27,856 versus $13,507) for stable kidney function during the first year.

Conclusion

The small fraction of MA enrollees with accelerated loss of kidney function have disproportionately higher costs than other enrollees with stage 2 CKD and may benefit from closer clinical management to minimize progression and contain costs.

Funding

  • Other U.S. Government Support