Objectives: Early diagnosis and treatment of chronic kidney disease (CKD) may delay disease progression and reduce the burden of disease. This study examined the epidemiology and treatment of CKD among commercially-insured patients in the U.S.
Methods: A retrospective cohort study was conducted using January 2010-December 2018 MarketScan® data. Patients with ≥2 outpatient (≥ 30 days apart) and/or ≥1 inpatient claims containing a diagnosis code for CKD were eligible for analysis. The earliest CKD diagnosis date served as the index date. Continuous enrollment for ≥6 months pre- and post-index was required. Baseline characteristics and use of ACE inhibitors and/or ARBs pre/post-index were analyzed for the overall CKD population and patients with pre-existing diabetes (Types 1 and 2). Annual CKD prevalence and incidence were calculated from the total enrollee population in a given year.
Results: Of 753,097 CKD patients identified, 310,837 (41.3%) had pre-existing diabetes. More CKD patients with pre-existing diabetes had hypertension (81.7% vs. 75.7% for overall CKD). Approximately 45% of patients in both cohorts were diagnosed at Stage 3. Overall CKD prevalence per 1,000 enrollees increased from 11.7 in 2011 to a high of 16.7 in 2016 before decreasing to 13 in 2018. Among persons with pre-existing diabetes, prevalence was 2.0 per 1,000 enrollees in 2011, falling to 1.6 in 2018, with a high of 2.83 in 2015. In the pre-index period, 55.3% of CKD patients overall and 66.2% of CKD patients with pre-existing diabetes received an ACE/ARB. Following CKD diagnosis, use of ACE/ARBs increased to 63.2% and 73.7% for the overall CKD and diabetes populations, respectively.
Conclusions: On a population basis, the annual incidence of new CKD patients enrolled in commercial plans is not inconsequential. Greater efforts are needed to identify patients at earlier stages of disease and ensure that treatment guidelines are being followed.
T. Kauf: Consultant; Self; Roche Diabetes Care. W. Wang: Consultant; Self; Roche Diabetes Care. A. Dillon: Consultant; Self; Roche Diabetes Care. I. Singh: Employee; Self; Roche Diabetes Care. J.T. Odegard: None. C. Ringemann: Employee; Self; Roche Diabetes Care. S. Haldrup: Employee; Self; F. Hoffmann-La Roche Ltd.