System Preparedness for Rising Kidney Replacement Therapy Demand: Late-Stage CKD Drives Costs, Healthcare Resource...

Chronic kidney disease (CKD) is a leading cause of global morbidity and mortality, affecting one in ten Swiss adults. Patient numbers are expected to increase due to demographic shift and increasing comorbidity rates, necessitating strategic healthcare planning. Holistic burden remains unknown and detailed projections-including expectations of prospective economic and environmental impact-are lacking. To inform Switzerland's public health strategies and support its 2050 net-zero healthcare goal, this study aims to forecast the multidimensional burdens of CKD.

The IMPACT-CKD microsimulation model was utilised to project CKD-progression and clinical, healthcare resource utilisation, economic, societal, and environmental outcomes in Switzerland over 10 years (2023-2032). Modelled individuals were assigned CKD-relevant characteristics-including kidney function, comorbidities and clinical events-based on real-world data. Individuals were categorised into non-CKD or one of six CKD stages and progressed through the disease, diagnosed or undiagnosed. Model inputs and outcomes were validated and calibrated against literature, real-world evidence, and expert consultation.

By 2032, IMPACT-CKD projects Switzerland's cases of CKD to rise by 6.7% (0.96m to 1.03m) with late-stage CKD and kidney replacement therapy (KRT) surging by 18.1% (437k to 516k) and 57.2% (8.4k to 13.2k). CKD-related healthcare costs are projected to increase by 27.6% (Swiss francs [CHF] 3.3b to CHF 4.2b), driven by a 77.3% rise KRT-related costs. CKD would account for 4.6% of the Swiss healthcare budget, incur CHF 12.9b in lost productivity, 43.2m missed workdays and CHF 606m in lost tax revenue. Greenhouse gas emissions are projected to increase by 12.9%, driven by rising dialysis demand.

IMPACT-CKD projects substantial increases in the multidimensional burdens of CKD in Switzerland. Impact could be mitigated via earlier detection and broader uptake of guideline-directed medical therapy. Comprehensive health policies and strategic public health planning are necessary to reduce burden and sustain Switzerland's 2050 net-zero healthcare ambition.