1
|
Zhang J, Diwan V, Wang Z, Healy HG, Venuthurupalli SK, Abeysekera R, Hoy WE. The Impact of Anaemia on Outcomes, Admissions, and Costs in Patients with Chronic Kidney Disease in Two Public Nephrology Practices in Queensland: A CKD.QLD Registry Study. Int J Nephrol 2023; 2023:8720293. [PMID: 37180548 PMCID: PMC10171986 DOI: 10.1155/2023/8720293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 03/24/2023] [Accepted: 04/10/2023] [Indexed: 05/16/2023] Open
Abstract
Aim Anaemia among patients with chronic kidney disease (CKD) leads to poor overall outcomes. This study explores anaemia and its impact on nondialysis CKD (NDD-CKD) patients. Methods 2,303 adults with CKD from two CKD.QLD Registry sites were characterised at consent and followed until start of kidney replacement therapy (KRT), death, or censor date. Mean follow-up was 3.9 (SD 2.1) years. Analysis explored the impact of anaemia on death, KRT start, cardiovascular events (CVE), admissions, and costs in these NDD-CKD patients. Results At consent, 45.6% patients were anaemic. Males were more often anaemic (53.6%) than females, and anaemia was significantly more common over the age of 65 years. The prevalence of anaemia was highest among CKD patients with diabetic nephropathy (27.4%) and renovascular disease (29.2%) and lowest in patients with genetic renal disease (3.3%). Patients with admissions for gastrointestinal bleeding had more severe anaemia, but accounted for only the minority of cases overall. Administration of ESAs, iron infusions, and blood transfusions were all correlated with more severe degrees of anaemia. The number of hospital admissions, length of stay, and hospital costs were all strikingly higher with more severe degrees of anaemia. Adjusted hazard ratios (CI 95%) of patients with moderate and severe anaemia vs. no anaemia for subsequent CVE, KRT, and death without KRT were 1.7 (1.4-2.0), 2.0 (1.4-2.9), and 1.8 (1.5-2.3), respectively. Conclusion Anaemia is associated with higher rates of CVE, progression to KRT and death in NDD- CKD patients, and with greater hospital utilisation and costs. Preventing and treating anaemia should improve clinical and economic outcomes.
Collapse
Affiliation(s)
- Jianzhen Zhang
- NHMRC CKD.CRE and CKD.QLD, Brisbane, QLD, Australia
- Centre for Chronic Disease, The University of Queensland, Brisbane, QLD, Australia
| | - Vishal Diwan
- NHMRC CKD.CRE and CKD.QLD, Brisbane, QLD, Australia
- Centre for Chronic Disease, The University of Queensland, Brisbane, QLD, Australia
| | - Zaimin Wang
- NHMRC CKD.CRE and CKD.QLD, Brisbane, QLD, Australia
- Centre for Chronic Disease, The University of Queensland, Brisbane, QLD, Australia
| | - Helen G. Healy
- NHMRC CKD.CRE and CKD.QLD, Brisbane, QLD, Australia
- Kidney Health Services, Metro North Hospital and Health Services, Brisbane, QLD, Australia
- School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Sree Krishna Venuthurupalli
- NHMRC CKD.CRE and CKD.QLD, Brisbane, QLD, Australia
- School of Medicine, University of Queensland, Brisbane, QLD, Australia
- Kidney Health Services, West Moreton Hospital and Health Services, Brisbane, QLD, Australia
| | - Rajitha Abeysekera
- School of Medicine, University of Queensland, Brisbane, QLD, Australia
- Centre for Education Research Training in Kidney Disease, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Wendy E. Hoy
- NHMRC CKD.CRE and CKD.QLD, Brisbane, QLD, Australia
- Centre for Chronic Disease, The University of Queensland, Brisbane, QLD, Australia
- School of Medicine, University of Queensland, Brisbane, QLD, Australia
| |
Collapse
|
2
|
Krikorian SA. Managing Anemia of Chronic Kidney Disease. Am J Lifestyle Med 2009. [DOI: 10.1177/1559827608327912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Anemia begins early in the course of declining kidney function and is a frequent complication of chronic kidney disease. Both anemia and chronic kidney disease are underdiagnosed and undertreated. Anemia is associated with significantly increased risk of morbidity and mortality, including increased risks of left ventricular hypertrophy and heart failure. Although the detrimental effects of anemia are more common in patients with advanced chronic kidney disease, it has been suggested that correcting anemia in early stage kidney disease may improve health-related quality of life and also delay the progression to end-stage kidney disease. The identification of anemia in early stage chronic kidney disease and its aggressive management may also improve cardiovascular complications. Anemia of chronic kidney disease is predominantly a result of abnormal erythropoietin production and iron deficiency. Anemia may be the result of kidney failure itself, blood losses, nutritional deficiencies, and endocrine disorders. Guidelines and protocols for treating anemia can assist practitioners in identifying patients with anemia, treating anemia, evaluating response to treatment, and modifying treatment based on response. Erythropoeisis-stimulating agents have been shown to be effective in treating anemia in predialysis and dialysis patients. Iron supplementation is usually required in patients receiving erythropoeisis-stimulating agent therapy or with iron deficiency. Successfully managing anemia of chronic kidney disease with treatment strategies that accommodate patient lifestyle and improve compliance is paramount. Primary care physicians play an important role in the care of patients with kidney disease, as does collaboration with other medical professionals involved in their care.
Collapse
Affiliation(s)
- Susan A. Krikorian
- Department of Pharmacy Practice, School of Pharmacy, Massachusetts College of Pharmacy and Health Sciences
| |
Collapse
|
3
|
Moyneur É, Bookhart BK, Mody SH, Fournier AA, Mallett D, Duh MS. The Economic Impact of Pre-Dialysis Epoetin Alfa on Health Care and Work Loss Costs in Chronic Kidney Disease: An Employer's Perspective. ACTA ACUST UNITED AC 2008; 11:49-58. [DOI: 10.1089/dis.2008.111715] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
| | | | - Samir H. Mody
- Ortho Biotech Clinical Affairs, LLC, Bridgewater, New Jersey
| | | | | | | |
Collapse
|
4
|
Rasu RS, Crawford T, Manley H, Balkrishnan R. Treatment and costs associated with anemic chronic kidney disease patients. Curr Med Res Opin 2008; 24:129-37. [PMID: 18034919 DOI: 10.1185/030079908x242782] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The purpose of this paper is to provide an overview of the current therapeutic options afforded to anemic chronic kidney disease (CKD) patients and the costs of these interventions. METHODOLOGY Literature search of articles within Ovid MEDLINE between 1996 and 2007 that pertained to the treatment of anemia in chronic kidney disease patients. RESULTS Early detection and treatment of anemia associated with CKD has proven to provide positive cognitive and physical effects. Treatment options that increase iron storage and availability within the body and production of erythropoietin can assist in anemic CKD patients in achieving recommended levels of hemoglobin. Acknowledgement of the potential side effects associated with the medications selected to treat anemia can help in avoiding additional injury to the patient and thus reduce healthcare expenditure. A limitation of this review is that the search was performed within a single database. CONCLUSIONS Health care providers can play an active role in detecting anemia early and optimizing available treatment options. Future research on the effects of erythropoiesis-stimulating agents (ESA) on patients before they need dialysis, and a cost analysis between epoetin and darbepoetin alpha, would be beneficial.
Collapse
Affiliation(s)
- Rafia S Rasu
- School of Pharmacy, University of Missouri Kansas City, Kansas City, MO 64106, USA.
| | | | | | | |
Collapse
|
5
|
Owens G, Emons MF, Christian-Herman J, Lawless G. Current Trends in Pharmacy Benefit Designs: A Threat to Disease Management in Chronic Complex Diseases. ACTA ACUST UNITED AC 2007; 10:74-82. [PMID: 17444792 DOI: 10.1089/dis.2006.638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
With a focus on those patients who are candidates for treatment with biologic agents, we review the impact that current pharmacy benefit trends have on patients with chronic complex diseases and how they affect opportunities for disease management in this unique patient population. Dramatic increases in health care costs have led to a variety of strategies to manage cost. Many of these strategies either limit access to care or increase the patient's responsibility for choosing and paying for care, especially for medications. These strategies have a disproportionate impact on patients with chronic complex diseases, particularly those who require the use of biologic medications. A fundamental prerequisite of disease management has been coverage of disease-modifying therapies. If current pharmacy benefit trends continue, unintended consequences will likely occur including lost opportunities for disease management. Current pharmacy benefit trends could adversely impact disease management, particularly for patients requiring the use of biologic agents. Health plans should consider innovative benefit designs that reflect an appropriate level of cost sharing across all key stake-holders, ensuring appropriate access to needed therapies. Additional research is needed to clarify the value of newer approaches to therapies or benefit design changes.
Collapse
Affiliation(s)
- Gary Owens
- Independence Blue Cross, Philadelphia, Pennsylvania, USA.
| | | | | | | |
Collapse
|
6
|
Ershler WB, Chen K, Reyes EB, Dubois R. Economic burden of patients with anemia in selected diseases. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2005; 8:629-38. [PMID: 16283863 DOI: 10.1111/j.1524-4733.2005.00058.x] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVE To examine the economic impact of patients with anemia in selected diseases. METHODS A retrospective cohort design was used to estimate the differences in costs between anemic and nonanemic patients. The analysis used administrative claims data (1999-2001) from a US population to assess direct costs and disability and productivity data (1997-2001) to estimate indirect costs. Adult patients with a diagnosis of rheumatoid arthritis (RA), inflammatory bowel disease (IBD), chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD), cancer, or congestive heart failure (CHF) were identified. Costs were estimated using a generalized linear model, adjusting for age, sex, comorbidities, and disease severity. The adjustment variables for disease severity were based on ICD-9, HCPCS, or pharmacy codes. These costs were projected to a 1-million-member, similar population. RESULTS The percentage of anemia patients varied among conditions (6.9-26.1%); the CKD population had the highest prevalence. CKD anemic patients incurred the greatest average annual direct costs ($78,209), followed by CHF ($72,078) and cancer ($60,447). After adjusting for baseline characteristics including severity, the difference in direct costs between anemic and nonanemic patients decreased for all diseases; CHF patients incurred the greatest adjusted cost difference between anemic and nonanemic ($29,511), followed by CKD ($20,529) and cancer ($18,418). Unmeasured severity and coding bias may account for a portion of the differences in the adjusted cost. CONCLUSION Anemia may substantially increase health-care costs at a level that is economically very relevant, despite the fact that these patients may comprise only one tenth of the overall anemic population.
Collapse
Affiliation(s)
- William B Ershler
- Institute for Advanced Studies in Aging and Geriatric Medicine, Washington, DC, USA
| | | | | | | |
Collapse
|
8
|
Kausz AT, Guo H, Pereira BJG, Collins AJ, Gilbertson DT. General Medical Care among Patients with Chronic Kidney Disease: Opportunities for Improving Outcomes. J Am Soc Nephrol 2005; 16:3092-101. [PMID: 16079268 DOI: 10.1681/asn.2004110910] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Suboptimal health care during advancing chronic kidney disease (CKD) may result in greater morbidity and cost once dialysis is started and may preclude future transplantation. Medicare data were examined for the prevalence of selected general health, diabetes, and CKD interventions in a national cohort of patients in the 2 yr before dialysis initiation and compared with a contemporaneous non-CKD cohort. A total of 24,778 individuals who were aged > or =67 yr composed the CKD cohort, and 1,046,136 individuals who were aged > or =67 yr did not have CKD. Among patients with diabetes and CKD, fewer than two thirds had claims for eye examinations, 75% for HbA(1C) testing, and 68% for lipid testing, with similar proportions in the non-CKD cohort. Among those without diabetes, 47 and 54% of the CKD and non-CKD cohorts, respectively, had claims for lipid testing. Fewer than 50 and 15% had claims for influenza and pneumococcal vaccination, respectively, with slightly lower proportions among patients with CKD. Claims for cancer tests were found for 14 to 41% and 29 to 52% of individuals with and without CKD, respectively, depending on the type of cancer. A greater proportion of patients with diabetes tended to have claims for tests in both cohorts. In the CKD cohort, claims for anemia testing and parathyroid hormone levels were available in fewer than 50 and 15%, respectively, and claims for permanent vascular access were found for only 30% of hemodialysis patients. This study provides further evidence that patients with CKD may not be receiving general health and CKD care according to current recommendations.
Collapse
Affiliation(s)
- Annamaria T Kausz
- Division of Nephrology, Tufts-New England Medical Center, 750 Washington Street, Box 391, Boston, MA 02111, USA.
| | | | | | | | | |
Collapse
|