Journal Mobile Options
Table of Contents
Vol. 29, No. 5, 2009
Issue release date: April 2009

Chronic Kidney Disease and US Healthcare Resource Utilization in a Nationally Representative Sample

Alexander M. · Bradbury B.D. · Kewalramani R. · Barlev A. · Mohanty S.A. · Globe D.
To view the fulltext, log in and/or choose pay-per-view option

Individual Users: Register with Karger Login Information

Please create your User ID & Password





Contact Information











I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in

Abstract

Background: Chronic kidney disease (CKD) is a prevalent condition; however, little is known about healthcare resource utilization (HRU) by CKD patients. Methods: This analysis included NHANES participants aged ≥18 years, with serum creatinine, urine protein, and hemoglobin measurements. We assessed the association between CKD (stratified by stage) and HRU based on self-reported physician visits and hospitalizations in the year preceding the survey. Results: Of the 15,258 included in this analysis, 2,110 had early CKD (stage 1 and 2 CKD) and 1,121 had late CKD (stage 3 and 4 CKD). Mean (SE) number of annual physician visits were 3.51 (0.08), 4.43 (0.18), and 6.53 (0.38) for participants with no CKD, early CKD, and late CKD, respectively. Mean (SE) number of annual hospitalizations were 0.15 (0.01), 0.19 (0.01), and 0.42 (0.03) for participants with no CKD, early CKD, and late CKD, respectively. Participants with late CKD were more likely to have more physician visits (OR 1.81, 95% CI 1.46, 2.23) and have more hospital admissions (OR 2.12, 95% CI 1.66, 2.71) compared with participants with early CKD or no CKD. Conclusions: In this analysis, late stage CKD was associated with increased HRU, suggesting the need for early identification and treatment of CKD and its associated conditions.



Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Orlando LA, Owen WF, Matchar DB: Relationship between nephrologist care and progression of chronic kidney disease. N C Med J 2007;68:9–16.
  2. Khan S, Amedia CA Jr: Economic burden of chronic kidney disease. J Eval Clin Pract 2008;14:422–434.
  3. McLaughlin K, Manns B, Culleton B, Donaldson C, Taub K: An economic evaluation of early versus late referral of patients with progressive renal insufficiency. Am J Kidney Dis 2001;38:1122–1128.
  4. Petrou S, Murray L, Cooper P, Davidson LL: The accuracy of self-reported healthcare resource utilization in health economic studies. Int J Technol Assess Health Care 2002;18:705–710.
  5. Ritter PL, Stewart AL, Kaymaz H, Sobel DS, Block DA, Lorig KR: Self-reports of healthcare utilization compared to provider records. J Clin Epidemiol 2001;54:136–141.
  6. Roberts RO, Bergstralh EJ, Schmidt L, Jacobsen SJ: Comparison of self-reported and medical record health care utilization measures. J Clin Epidemiol 1996;49:989–995.
  7. K/DOQI: Clinical practice guidelines on hypertension and antihypertensive agents in chronic kidney disease. Am J Kidney Dis 2004;43:S1–S290.
  8. Bakker AJ: Detection of microalbuminuria. Receiver operating characteristic curve analysis favors albumin-to-creatinine ratio over albumin concentration. Diabetes Care 1999;22:307–313.
  9. Chan MR, Dall AT, Fletcher KE, Lu N, Trivedi H: Outcomes in patients with chronic kidney disease referred late to nephrologists: a meta-analysis. Am J Med 2007;120:1063–1070.
  10. Vlagopoulos PT, Tighiouart H, Weiner DE, Griffith J, Pettitt D, Salem DN, Levey AS, Sarnak MJ: Anemia as a risk factor for cardiovascular disease and all-cause mortality in diabetes: the impact of chronic kidney disease. J Am Soc Nephrol 2005;16:3403–3410.
  11. Langston RD, Presley R, Flanders WD, McClellan WM: Renal insufficiency and anemia are independent risk factors for death among patients with acute myocardial infarction. Kidney Int 2003;64:1398–1405.
  12. Jurkovitz CT, Abramson JL, Vaccarino LV, Weintraub WS, McClellan WM: Association of high serum creatinine and anemia increases the risk of coronary events: results from the prospective community-based Atherosclerosis Risk in Communities (ARIC) Study. J Am Soc Nephrol 2003;14:2919–2925.
  13. Mix TC, St Peter WL, Ebben J, Xue J, Pereira BJ, Kausz AT, Collins AJ: Hospitalization during advancing chronic kidney disease. Am J Kidney Dis 2003;42:972–981.
  14. Go AS, Yang J, Ackerson LM, Lepper K, Robbins S, Massie BM, Shlipak MG: Hemoglobin level, chronic kidney disease, and the risks of death and hospitalization in adults with chronic heart failure: the Anemia in Chronic Heart Failure: Outcomes and Resource Utilization (ANCHOR) Study. Circulation 2006;113:2713–2723.
  15. NHANES III Analytic and Reporting Guidelines. Hyattsville/Md, National Center for Health Statistics, Centers for Disease Control and Prevention. 1996 (accessed at http://www.cdc.gov/nchs/data/nhanes/nhanes3/nh3gui.pdf, 2007).
  16. World Health Organization. Obesity: Preventing and Managing the Global Epidemic. Report of a WHO Consultation. Tech Rep Ser No 894. Geneva, WHO, 2000.
  17. National Kidney Foundation: K/DOQI Clinical Practice Guideline and Clinical Practice Recommendations for anemia in chronic kidney disease: 2007 update of hemoglobin target. Am J Kidney Dis 2007;50:471–530.
  18. Coresh J, Astor BC, McQuillan G, Kusek J, Greene T, Van Lente F, Levey AS: Calibration and random variation of the serum creatinine assay as critical elements of using equations to estimate glomerular filtration rate. Am J Kidney Dis 2002;39:920–929.
  19. Manjunath G, Sarnak MJ, Levey AS: Prediction equations to estimate glomerular filtration rate: An update. Curr Opin Nephrol Hypertens 2001;10:785–792.
  20. Levey AS, Greene T, Kusek JW, Beck GJ: A simplified equation to predict glomerular filtration rate from serum creatinine (abstract). J Am Soc Nephrol 2000;11:A0828.

    External Resources

  21. Levey AS, Coresh J, Balk E, Kausz AT, Levin A, Steffes MW, Hogg RJ, Perrone RD, Lau J, Eknoyan G: National kidney foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med 2003;139:137–147.
  22. Coresh J, Astor BC, Greene T, Eknoyan G, Levey AS: Prevalence of chronic kidney disease and decreased kidney function in the adult us population: Third National Health and Nutrition Examination Survey. Am J Kidney Dis 2003;41:1–12.
  23. Ezzati TM, Massey JT, Waksberg J, Chu A, Maurer KR: Sample design: Third National Health and Nutrition Examination Survey. Vital Health Statistics 2 1992;113:1–35.
  24. Plan and Operation of the Third National Health and Nutrition Examination Survey, 1988–1994. Vital Health Statistics 1 1994;32:1–407.
  25. Centers for Disease Control and Prevention (CDC): Hospitalization discharge diagnoses for kidney disease – United States, 1980–2005. MMWR 2008;57:309–312.

    External Resources

  26. Smith DH, Gullion CM, Nichols G, Keith DS, Brown JB: Cost of medical care for chronic kidney disease and comorbidity among enrollees in a large HMO population. J Am Soc Nephrol 2004;15:1300–1306.
  27. Khan SS, Kazmi WH, Abichandani R, Tighiouart H, Pereira BJ, Kausz AT: Health care utilization among patients with chronic kidney disease. Kidney Int 2002;62:229–236.
  28. US Renal Data System, USRDS 2007 Annual Data Report: Atlas of enD-STAGE RENAL DISEASE in the United States. Bethesda, NIH, National Institute of Diabetes and Digestive and Kidney Diseases, 2007.
  29. Coresh J, Byrd-Holt D, Astor BC, Briggs JP, Eggers PW, Lacher DA, Hostetter TH: Chronic kidney disease awareness, prevalence, and trends among US adults, 1999–2000. J Am Soc Nephrol 2005;16:180–188.
  30. Coresh J, Selvin E, Stevens LA, Manzi J, Kusek JW, Eggers P, Van Lente F, Levey AS: Prevalence of chronic kidney disease in the united states. JAMA 2007;298:2038–2047.


Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50