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Chronic kidney disease (CKD) imposes a significant burden on individuals and society due to its associated increased morbidity and mortality. However, multinational real-world data characterizing the healthcare resource utilization (HCRU) in patients with CKD are limited. Here, we describe the 12-month HCRU among patients enrolled in the DISCOVER CKD prospective cohort study.
DISCOVER CKD (ClinicalTrials.gov identifier: NCT04034992) is a multicounty, non-interventional, cohort study designed to characterize the epidemiology of CKD, including describing patient characteristics, disease progression, clinical outcomes, patient journey, practice patterns, and clinical management. The study follows an ambispective design with retrospective and prospective components. In the prospective phase, patients with CKD were recruited from the UK, Spain, Italy, Sweden, Japan, and the USA. Data were extracted from patients’ health records by the treating physician and manually entered into an electronic case report form developed specifically for the study. The study received research ethics board approval and all patients provided signed informed consent. In the current analysis, only patients who completed up to the 12-month (±3 months) follow-up visits were included. Rates of HCRU—defined as the total number of visits or use of healthcare resource divided by the follow-up duration and expressed as per 100 person-years—were estimated for ambulance use, outpatient visits, specialist use/referral, emergency room (ER) visits, use of supportive care (including use of psychologist, cognitive behavioral therapy, dietitian, community nurse, occupational therapist, or chiropodist), and all-cause hospitalization.
In all, 1052 patients (mean age, 62.5 years; 36.9% female) with CKD (Stage 2 [n=87]; Stage 3A [n=332]; Stage 3B [n=308]; Stage 4 [n=184]; Stage 5 [n=141]) were enrolled between September 2019 and June 2022 across the 6 countries (USA [n=321]; Italy [n=104]; Spain [n=129]; Sweden [n=90]; Japan [n=223]; UK [n=185]) of whom 755 (71.8%) completed the 12-month follow-up visit. ER visits, specialist use/referral, ambulance use, outpatient visits, all-cause hospitalization, and use of supportive care were frequent, occurring in 15.2%, 19.9%, 3.5%, 54.9%, 24.3%, and 9.7% of patients, respectively. The corresponding rates were 36.0, 100.2, 6.0, 412.5, 51.5, and 67.2 per 100 person-years, respectively. In general, HCRU was higher in patients with advanced-stage CKD (4–5) compared to patients with early-stage CKD (2–3). HCRU varied widely across countries, with ER visits, specialist referral, and ambulance use numerically highest in the USA, outpatient visits numerically highest in Japan, all-cause hospitalization numerically highest in the UK, and use of supportive care numerically lowest in Italy (Figure).
These data reveal substantial HCRU associated with CKD. The variability in HCRU across countries may be due to a myriad of factors including patient- and health system–specific factors. Early CKD screening in tandem with proactive disease management may contribute to improved patient outcomes and result in a significant HCRU saving for healthcare providers.