Identifying chronic kidney disease stage 3 with excess disease burden

Area of Science:

• Nephrology
• Health Services Research
• Epidemiology

Background:

• Chronic kidney disease (CKD) is a prevalent condition with variable progression.
• Current guidelines recommend nephrology referral for CKD stage 4.
• Early nephrologist referral may improve patient outcomes.

Purpose of the Study:

• To identify if a subset of CKD stage 3 patients with comorbidities warrants earlier nephrology referral.
• To analyze disease progression, cost, and utilization patterns in CKD stage 3 patients with comorbidities.
• To evaluate the potential benefit of earlier intervention for at-risk CKD stage 3 patients.

Main Methods:

• Retrospective study of Medicare beneficiaries with CKD stages 3-5 and end-stage kidney disease.
• Identified 7 key comorbidities associated with progressive CKD.
• Segmented CKD stage 3 beneficiaries based on comorbidity presence and compared outcomes.

Main Results:

• 35.4% of CKD stage 3 patients had at least one selected comorbidity (CKD stage 3-plus).
• The CKD stage 3-plus cohort exhibited cost and utilization patterns similar to CKD stages 4 and 5.
• These findings suggest increased risk and resource use in this subgroup.

Conclusions:

• A claims-based algorithm can identify high-cost, at-risk CKD stage 3 patients.
• This subset of CKD stage 3 patients may benefit from earlier nephrology intervention.
• Findings support re-evaluation of current nephrology referral guidelines.