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Kidney Week

Abstract: SA-PO491

Change in Urine Albumin-to-Creatinine Ratio (UACR) and Health Care Resource Utilization (HRU) and Costs in Patients with Type 2 Diabetes (T2D) and CKD

Session Information

Category: Diabetic Kidney Disease

  • 702 Diabetic Kidney Disease: Clinical

Authors

  • Tangri, Navdeep, Department of Community Health Services, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
  • Li, Qixin, Bayer U.S. LLC, Whippany, New Jersey, United States
  • Chen, Yan, Analysis Group Inc, Los Angeles, California, United States
  • Singh, Rakesh, Bayer U.S. LLC, Whippany, New Jersey, United States
  • Betts, Keith A., Analysis Group Inc, Los Angeles, California, United States
  • Farag, Youssef MK, Bayer U.S. LLC, Whippany, New Jersey, United States
  • Beeman, Scott, Bayer U.S. LLC, Whippany, New Jersey, United States
  • Du, Yuxian, Bayer U.S. LLC, Whippany, New Jersey, United States
  • Kong, Sheldon X., Bayer U.S. LLC, Whippany, New Jersey, United States
  • Williamson, Todd E., Bayer U.S. LLC, Whippany, New Jersey, United States
  • Wu, Aozhou, Analysis Group Inc, Los Angeles, California, United States
  • Rabideau, Brendan, Analysis Group Inc, Los Angeles, California, United States
  • Pantalone, Kevin M., Department of Endocrinology, Cleveland Clinic, Cleveland, Ohio, United States
Background

UACR is an important measure of kidney damage, but the impact of changes in UACR on HRU and costs in patients with T2D and CKD is unclear.

Methods

We used the Optum electronic health records database (01/2007-09/2021) to identify adult patients with albuminuria, measured by UACR ≥30 mg/g (initial test) after diagnosis of T2D and CKD. UACR change was categorized as increased (>30% change), stable (-30% to 30%), or decreased (<-30%) based on the percent change between the initial test and the last test (between 183-730 days after the initial test). All-cause inpatient (IP) admissions, emergency room (ER) visits, outpatient (OP) visits, and total medical costs were evaluated during the 1 year after the last test. The association of UACR change with HRU was evaluated using Poisson regression, adjusting for key baseline characteristics. Medical costs (2022 USD) were estimated using a unit cost approach based on HRU frequencies.

Results

Among 144,814 patients eligible for the study, 81,084 (56%) had decreased, 31,766 (22%) had stable, and 31,964 (22%) had increased UACR. Compared with patients with stable UACR (IP admissions: 0.18 per-person-per-year [PPPY]; ER visits: 0.31 PPPY; OP visits: 19.13 PPPY; costs: $12,521), those with decreased UACR had similar HRU (IP: 0.17 PPPY; ER: 0.31 PPPY; OP: 19.90 PPPY) and annual medical costs ($12,329), while those with increased UACR had higher HRU (IP: 0.24 PPPY; ER: 0.35 PPPY; OP: 21.20 PPPY) and costs ($15,013). Compared with patients with stable UACR, those with decreased UACR had adjusted incidence rate ratios of 0.97 (95% CI: 0.93-1.01) for IP, 0.97 (0.94-1.01) for ER, and 1.02 (1.01-1.03) for OP. Patients with increased UACR had adjusted incidence rate ratios of 1.22 (1.17-1.28) for IP, 1.10 (1.05-1.15) for ER, and 1.07 (1.05-1.08) for OP compared with patients with stable UACR.

Conclusion

Among patients with T2D and CKD who had albuminuria, increases in UACR were associated with higher HRU and costs compared to patients with stable UACR, while decreases in UACR were associated with similar HRU and costs. Mitigating increases in UACR could yield economic benefits for this patient population.

Funding

  • Commercial Support – Bayer U.S. LLC