Costs and Healthcare Resource Use Associated with Risk of Cardiovascular Morbidity in Patients with Chronic Kidney Disease: Evidence from a Systematic Literature Review

Abstract

Introduction: The management of chronic kidney disease (CKD) costs in excess of $114 billion in the USA and £1.45 billion in the UK annually and is projected to increase alongside the increasing disease prevalence. The aim of this review was to evaluate the risks of cardiovascular (CV) morbidity, CV mortality or all-cause mortality based on KDIGO (Kidney Disease: Improving Global Outcomes) 2012 categorisations and estimate the additional costs and healthcare resource utilisation associated with CV morbidity linked to CKD severity in US and UK settings.

Methods: A systematic literature review was conducted of studies reporting on the risk of CV morbidity, CV mortality or all-cause mortality characterised by CKD severity (published between January 2000 and September 2018). Additional costs and bed days associated with CKD severity in the USA and UK were estimated on the basis of median hazard ratios for CV morbidity risk at each CKD and albuminuria stage.

Results: Twenty-nine studies reported risk of adverse clinical outcomes based on KDIGO categorisations. Compared to stage 1 (or without) CKD, patients with stage 5 CKD and macroalbuminuria experienced a relative risk increase of 11.77-12.46 across all outcomes. Additional costs and bed days associated with stage 5 CKD and macroalbuminuria (versus stage 1 (or without) CKD) per 1000 patient years were US$3.93 million and 803 bed days and £435,000 and 1017 bed days, in the USA and UK, respectively.

Conclusion: Risks of adverse clinical outcomes increase with CKD and albuminuria severity and are associated with substantial additional costs and resource utilisation. Thus, early diagnosis and proactive management of CKD and its complications should be a priority for healthcare providers to alleviate the burden of CV morbidity and its management on healthcare resources.

Keywords: Albuminuria; Cardiovascular morbidity; Chronic kidney disease; Healthcare resource utilisation; Systematic literature review.

Fig. 1

Associations between eGFR (left axis), albuminuria (right axis) and the risk of cardiovascular events (first column), cardiovascular mortality (second column) and all-cause mortality (third column). Data are mean (95% CI) hazard ratios for the risk of outcome at each eGFR and albuminuria stage from the subgroup of 29 studies that met the inclusion criteria and reported combined associations between eGFR, albuminuria and the risk of adverse clinical outcomes. Risk is for each CKD and albuminuria stage vs. stage 1 (or without) CKD and normoalbuminuria. Increase in risk is vs. stage 1 (or without) CKD with normoalbuminuria