Abstract: TH-PO1041
Quantifying the Delay from Laboratory-Based Detection to Diagnosis of CKD in the United States
Session Information
- CKD Progression and Complications: Diagnosis, Prognosis, Risk Factors
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Chatterjee, Satabdi, Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, Connecticut, United States
- Levy, Adrian R., Dalhousie University, Halifax, Nova Scotia, Canada
- Donato, Bonnie M.k., Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, Connecticut, United States
- Zhang, Ling, Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, Connecticut, United States
- Stackland, Sydnie, Panalgo LLC, Boston, Massachusetts, United States
- Kovesdy, Csaba P., The University of Tennessee Health Science Center, Memphis, Tennessee, United States
Background
While delays from chronic kidney disease (CKD) onset to diagnosis are common, these delays have yet to be quantified. The study objective was to quantify the delay from laboratory-based physiologic detection (using eGFR) to diagnosis of CKD (using ICD 9/10 code).
Methods
A retrospective cohort study was conducted using 2009 -2020 Optum® Market Clarity data. Individuals aged 18 years and older, who had two laboratory records showing eGFR < 60 mL/min/1.73 m2, 3-12 months apart, were included. The second eGFR < 60 was defined as the index date. Patients with pre-existing ICD code of CKD during the 12-month pre-index period (baseline), or before the first eGFR <60 were excluded. Individuals were followed from the index date until a diagnosis of CKD or censoring (date of death, end of follow-up, or disenrollment). Cohorts were stratified by the presence or absence of comorbid diabetes and heart failure (HF) at baseline. Survival analysis was performed to evaluate the factors associated with delays in diagnosis, for overall and stratified cohorts.
Results
A total of 1.39 million adults with laboratory evidence of CKD (mean (±SD) age 71 (±10); 63% women; 87% Caucasian) were included. Over 90% of them were in KDIGO stage 3, 5% in stage 4 and 1% in stage 5. Overall, 62% of individuals had neither diabetes nor HF, 24% had diabetes, 8% had HF, and 6% had both. The mean follow-up was 2.7 (SD 2.4) years. Overall, the median time to CKD diagnosis was 469 days (interquartile range [IQR]: 120-1062); time to CKD diagnosis was 537 days (IQR: 152-1163) among those without diabetes or HF, 449 days (IQR: 114-1007) among those only with diabetes, 319 days (IQR: 62-793) among those with only HF, and 270 days (IQR: 54-694) among those with both diabetes and HF. Factors associated with longer time to CKD diagnosis included: absence of diabetes or HF; less severe CKD; younger age; female sex; and Caucasian race.
Conclusion
In a large cohort of individuals with laboratory-based evidence of CKD, the time to diagnosis was delayed, on average, by over a year. In light of newer therapies that can slow kidney disease progression and reduce cardiovascular complications, these findings reinforce the need for early recognition of CKD that would inform optimal guideline-based treatment and improve outcomes in these patients.
Funding
- Commercial Support – Boehringer Ingelheim