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Abstract: PO2411

The Kidney Failure Risk Equation as a Predictor of Healthcare Costs

Session Information

Category: CKD (Non-Dialysis)

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

Authors

  • Reaven, Nancy L., Strategic Health Resources, La Canada, California, United States
  • Funk, Susan E., Strategic Health Resources, La Canada, California, United States
  • Mathur, Vandana S., MathurConsulting, Woodside, California, United States
  • Lai, Julie C., Strategic Health Resources, La Canada, California, United States
  • Tangri, Navdeep, Division of Nephrology, University of Manitoba,, Winnipeg, Manitoba, Canada
Background

The Kidney Failure Risk Equations (KFRE) are accurate and validated to predict the risk of kidney failure in individuals with CKD, but little is known about their potential to predict healthcare costs. We assessed the 4- and 8-variable 2-year KFRE models as independent predictors of monthly healthcare costs in patients with CKD stages 3-4.

Methods

Optum’s de-identified Integrated Claims-Clinical dataset of US patients (2007-2017) was queried to identify patients with non-dialysis CKD stages 3-4 (90-day average eGFR ≥15 to <60 mL/min/1.73 m2) followed by 2 consecutive serum bicarbonate 12 to <30 mEq/L, 28–365 days apart, with 6 months pre-index data and ≥2 years of post-index or death within 2 years, plus concurrent medical claims. The first qualifying serum bicarbonate test established the index date. KFRE elements were evaluated during the pre-index period and predicted risk scores of 2-year kidney failure were computed for each patient. Monthly medical costs were calculated for each patient from individual healthcare insurance claims and log-transformed due to skew. Patients were also stratified by index CKD stage. Generalized linear regression models were used to examine the association of KFRE score and costs. The individual components of the KFRE were similarly analyzed.

Results

1721 patients qualified for this observational study (1475 and 246 with CKD stage 3 and 4 at index, respectively). Both the 4- and 8-variable KFRE assessments were associated with log monthly medical costs. Per 1% increased risk for 2-year kidney failure risk predicted by KFRE, costs were increased significantly: for CKD stage 3 (parameter estimates: 0.065 [P=0.016] and 0.126 [P<0.0001]) and for CKD stage 4 (parameter estimates: 0.029 [P=0.001] and 0.040 [P<0.0001]). Of the individual components, lower serum albumin and lower serum bicarbonate were consistently associated with higher monthly medical costs.

Conclusion

Both the 4- and 8-variable KFRE were associated with higher medical costs for patients with CKD stages 3 or 4, with monthly medical cost increases of 6.7% - 13.5% for CKD stage 3 and 2.9% - 4.1% for CKD stage 4, respectively, for each 1% increase in 2-year kidney failure risk. The KFRE may be a useful tool to anticipate medical costs for patients at risk of kidney failure.

Funding

  • Commercial Support –