Health claims databases used for kidney research around the world

Abstract

Health claims databases offer opportunities for studies on large populations of patients with kidney disease and health outcomes in a non-experimental setting. Among others, their unique features enable studies on healthcare costs or on longitudinal, epidemiological data with nationwide coverage. However, health claims databases also have several limitations. Because clinical data and information on renal function are often lacking, the identification of patients with kidney disease depends on the actual presence of diagnosis codes only. Investigating the validity of these data is therefore crucial to assess whether outcomes derived from health claims data are truly meaningful. Also, one should take into account the coverage and content of a health claims database, especially when making international comparisons. In this article, an overview is provided of international health claims databases and their main publications in the area of nephrology. The structure and contents of the Dutch health claims database will be described, as well as an initiative to use the outcomes for research and the development of the Dutch Kidney Atlas. Finally, we will discuss to what extent one might be able to identify patients with kidney disease using health claims databases, as well as their strengths and limitations.

Keywords: CKD; dialysis; epidemiology; health claims data; health claims database; kidney transplantation.

FIGURE 1

Examples of the Dutch Kidney Atlas. (A) Geographical variation of the number of patients with CKD Stages G4–G5 (diagnosis code eGFR <30 mL/min/1.73 m²) not treated with RRT by province of The Netherlands, 2017; numbers per million insured population. (B) Total healthcare costs (€) of patients with CKD Stages G4–G5 (diagnosis code eGFR <30 mL/min/1.73 m²) not treated with RRT compared with a matched control group (2017, presented for the total group and different age groups). (C) Statin use in prevalent dialysis patients (2017, percentage of the total population), presented for the total group and different age groups. (D) Percentage of kidney transplant patients visiting the emergency department per year (2017), presented for the total group and subgroups based on age and gender.