All-cause costs increase exponentially with increased chronic kidney disease stage

Ladan Golestaneh, Paula J. Alvarez, Nancy L. Reaven, Susan E. Funk, Karen J. McGaughey, Alain Romero, Melanie S. Brenner, Macaulay Onuigbo

Research output: Contribution to journalArticlepeer-review

86 Scopus citations


OBJECTIVE: To evaluate the economic impact of chronic kidney disease (CKD) on US health plans.

STUDY DESIGN: A retrospective analysis identified patients with a renin-angiotensin-aldosterone system inhibitor (RAASi) prescription from an electronic medical record (EMR) database (Humedica); those with =90 days in =1 CKD stage were selected based on estimated glomerular filtration rate or diagnosis code, and a cohort on RAASi medications without CKD was selected. Costs for specific services obtained from OptumInsight were applied to services in EMR data of patients aged <65 years (commercial) and =65 years (Medicare). Dialysis costs were excluded.

RESULTS: The study included 106,050 patients with CKD and 56,761 no-CKD controls (90,302 commercial and 72,509 Medicare overall). Mean annualized all-cause costs increased exponentially with advancing stage, from $7537 (no CKD) to $76,969 (CKD stages 4-5) in the commercial group, and $8091 (no CKD) to $46,178 (CKD stages 4-5) in the Medicare group (P <.001; all comparisons with preceding disease stage). Mean costs for end-stage renal disease (ESRD) patients were $121,948 and $87,339 in the commercial and Medicare groups, respectively. Inpatient costs were the largest contributor to total costs, and their relative contribution increased with advancing CKD.

CONCLUSIONS: Cost to US health plans increases exponentially with each CKD stage progression. ESRD costs are even higher. Because readmissions lead to higher costs, efforts to reduce readmissions would result in cost reductions. Furthermore, healthcare reengineering paradigms that manage increasing comorbidities with advancing CKD, including heart failure, diabetes, and hyperkalemia, should offer additional potential for cost reductions.

Original languageEnglish (US)
Pages (from-to)S163-S172
JournalThe American journal of managed care
Issue number10
StatePublished - Jun 1 2017

ASJC Scopus subject areas

  • Health Policy


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