HEALTHCARE RESOURCE UTILISATION IN PATIENTS WITH CHRONIC KIDNEY DISEASE AND CO-EXISTING CARDIO-RENAL-METABOLIC CONDITIONS IN JAPAN: RESULTS FROM A REAL-WORLD SURVEY

Chronic kidney disease (CKD) is a persistent and increasing global healthcare concern associated with high individual and health care costs. It is well-documented that CKD is strongly related with other burdensome diseases including hypertension, diabetes and cardiovascular disease (CVD), which remain the leading causes of morbidity and premature death in this patient population. Whilst several real-world studies report the prevalence of individual comorbidities such as hypertension and diabetes in CKD, there remains a distinct paucity of evidence that describes the healthcare resource utilisation (HCRU) associated with co-existing cardio-renal-metabolic (CRM) conditions in CKD in Japan. This study seeks to describe the impact of co-existing CRM conditions in CKD on HCRU in Japan.

Data were drawn from the Adelphi Real World CKD Disease Specific Programme™, a cross-sectional survey of CKD-treating nephrologists and general practitioners in Japan in 2018. Physicians reported patient demographics, concomitant conditions, frequency of consultations, testing, and hospitalisations over the previous 12 months, for approximately 6 consecutively consulting CKD patients, who were stages 3a to 5 at the time of data collection. Analyses were descriptive.

In total, 59 physicians reported data for 363 patients with CKD. Mean [standard deviation; SD] patient age was 63.4 [12.4] years and 64% were male. At time of data collection, 19% of patients were CKD stage 3a, 18% were stage 3b, 39% were stage 4, and 24% were stage 5. 94% of the total patient population were reported as having a co-existing CRM condition in addition to their CKD (Table 1). Of those with a co-existing CRM condition, 85% had a co-existing cardiovascular condition, (79% hypertension; 15% other CVD) and 34% had type 2 diabetes mellitus. In the 12 months prior to data collection, CKD patients with co-existing CRM conditions attended a mean [SD] of 14.2 [14.8] specialist appointments for their CKD. A mean [SD] of 13.7 [8.8] laboratory tests were conducted to monitor patients’ CKD, including a mean [SD] of 9.1 [7.3] serum creatinine, 9.1 [7.2] blood haemoglobin, 7.2 [5.1] eGFR, 6.9 [4.1] urine protein-creatinine ratio, and 3.7 [3.9] urine albumin-creatinine ratio tests. 11% of patients had undergone a renal biopsy within the last 12 months. 23% of patients were haemodialysis-dependent, attending their regular dialysis sessions at a hospital (47%), dialysis clinic (49%) or dialysis centre (4%). Patients experienced a mean [SD] of 0.2 [0.4] hospitalisations in the previous 12 months for their CKD. At most recent hospitalisation, 20% were admitted via emergency room, with 6% requiring intensive care. Median [interquartile range] duration of stay was 14.0 [10.0–21.0] days.

These results indicate a high prevalence of concomitant hypertension and elevated risk for CVD in consulting CKD patients in Japan. Patients with co-existing CRM conditions present a substantive HCRU burden in Japan across a range of parameters, including elevated frequency of specialist consultations and associated tests to monitor their disease. Future analyses should seek to estimate the economic costs associated with elevated HCRU, the impact of multimorbidity on economic and quality of life outcomes, and to describe the humanistic burden associated with this patient population.