Comorbidities Increase Clinical and Economic Burden for Patients With Chronic Kidney Disease
Key Takeaways:
- Patients with chronic kidney disease (CKD) had higher health care resource utilization (HRCU) when combined with type 2 diabetes and/or heart failure. Patients with heart failure in addition to CKD had the highest overall HCRU across multiple care settings.
- Patients with heart failure in addition to CKD had higher total all-cause care costs than those without heart failure. Patients with CKD who had both type 2 diabetes and heart failure had the highest total costs overall.
- Patients with heart failure in addition to CKD had higher CKD-related care costs than those without heart failure. Again, patients with CKD who had both type 2 diabetes and heart failure had the highest total costs overall.
CKD often has a large economic burden due to high care costs, and this burden is amplified when patients with CKD also have type 2 diabetes or heart failure, which complicates disease management. A study assessed the clinical and economic burden of CKD and CKD plus type 2 diabetes and/or heart failure in Medicare Fee-for-Service (FFS) beneficiaries.
The study observed Medicare FFS patients newly diagnosed with CKD between January 2014 and December 2022. Clinical outcomes and care costs within the first 12 months of diagnosis were evaluated.
The total sample size contained 2 260 075 patients with CKD. Of this population, 56.5% had only CKD, 30.9% had CKD and type 2 diabetes, 7.2% had CKD and heart failure, and 5.4% had CKD and both type 2 diabetes and heart failure.
Heart Failure Increased Health Care Utilization and Costs in CKD
Cohorts that included heart failure had higher HCRU overall. HCRU significantly increased during the 12-month period across all cohorts for inpatient, emergency department (ED), and ICU settings.
Cohorts that included heart failure also had the highest total all-cause care costs. The CKD plus type 2 diabetes and heart failure had an average all-cause cost of $54 477; CKD plus heart failure, $47 668; CKD plus type 2 diabetes, $29 602; the CKD-only cohort, $24 180. Most costs were associated with care from inpatient settings. Just as with HCRU, the care costs increased by the end of 12 months across all cohorts.
For CKD-related costs, cohorts that included heart failure again had the highest total costs. The CKD plus type 2 diabetes and heart failure had an average total cost of $19 194; CKD plus heart failure, $16 153; CKD plus type 2 diabetes, $9787; CKD-only, $6710. Similarly, inpatient spending accounted for the majority of CKD-related care costs.
Managing Comorbidities Could Reduce CKD-Related Health Care Utilization
The CKD plus heart failure and type 2 diabetes had the highest clinical and economic burden among all the cohorts. Patients in this cohort had higher HCRU and accumulated higher all-cause and CKD-related care costs than any other cohort, demonstrating the impact of comorbidities on disease management and care costs.
The study’s findings have broad implications for preventing and treating CKD. The authors said, “Clinical pharmacist-led comprehensive medication reviews may significantly improve patients’ knowledge, attitudes, and adherence to interventions, ultimately supporting improved CKD (and related comorbidity) management and reducing avoidable hospitalizations and health care costs. Moreover, screening, diagnosis, and treatment programs and practices to identify earlier stages of CKD and prevent progression of CKD by primary care and specialties are also needed.”
Reference
Lee LY, Epstein AJ, Chatterjee S, Marcum ZA, Bengtson LGS. Clinical and economic burden of chronic kidney disease in Medicare fee-for-service beneficiaries with and without comorbid type 2 diabetes and heart failure: a retrospective cohort study. J Manage Care Spec Pharm. 2025;32(2):152-165. doi:10.18553/jmcp.2025.25167
