Section of Nephrology, Department of Medicine, Regina General Hospital, Regina, Saskatchewan, Canada.
Economics Department, Saskatchewan Medical Association, Saskatoon, Saskatchewan, Canada.
Clin J Am Soc Nephrol. 2022 Jan;17(1):17-26. doi: 10.2215/CJN.06770521. Epub 2021 Dec 30.
Patients with CKD exhibit heterogeneity in their rates of progression to kidney failure. The kidney failure risk equation (KFRE) has been shown to accurately estimate progression to kidney failure in adults with CKD. Our objective was to determine health care utilization patterns of patients on the basis of their risk of progression.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We conducted a retrospective cohort study of adults with CKD and eGFR of 15-59 ml/min per 1.73 m enrolled in multidisciplinary CKD clinics in the province of Saskatchewan, Canada. Data were collected from January 1, 2004 to December 31, 2012 and followed for 5 years (December 31, 2017). We stratified patients by eGFR and risk of progression and compared the number and cost of hospital admissions, physician visits, and prescription drugs.
In total, 1003 adults were included in the study. Within the eGFR of 15-29 ml/min per 1.73 m group, the costs of hospital admissions, physician visits, and drug dispensations over the 5-year study period comparing high-risk patients with low-risk patients were (Canadian dollars) $89,265 versus $48,374 (=0.008), $23,423 versus $11,231 (<0.001), and $21,853 versus $16,757 (=0.01), respectively. Within the eGFR of 30-59 ml/min per 1.73 m group, the costs of hospital admissions, physician visits, and prescription drugs were $55,944 versus $36,740 (=0.10), $13,414 versus $10,370 (=0.08), and $20,394 versus $14,902 (=0.02) in high-risk patients in comparison with low-risk patients, respectively, for progression to kidney failure.
In patients with CKD and eGFR of 15-59 ml/min per 1.73 m followed in multidisciplinary clinics, the costs of hospital admissions, physician visits, and drugs were higher for patients at higher risk of progression to kidney failure by the KFRE compared with patients in the low-risk category. The high-risk group of patients with CKD and eGFR of 15-29 ml/min per 1.73 m had stronger association with hospitalizations costs, physician visits, and drug utilizations.
慢性肾脏病（CKD）患者的肾功能衰竭进展速度存在异质性。肾脏衰竭风险方程（KFRE）已被证明可以准确地评估 CKD 成人的肾功能衰竭进展风险。我们的目的是根据患者的进展风险确定其医疗保健利用模式。
设计、地点、参与者和测量方法：我们对加拿大萨斯喀彻温省多学科 CKD 诊所中 eGFR 为 15-59ml/min/1.73m2 的 CKD 成人进行了回顾性队列研究。数据收集时间为 2004 年 1 月 1 日至 2012 年 12 月 31 日，随访 5 年（2017 年 12 月 31 日）。我们根据 eGFR 和进展风险对患者进行分层，并比较了高风险和低风险患者的住院次数、就诊次数和处方药数量和费用。
共纳入 1003 名成年人。在 eGFR 为 15-29ml/min/1.73m2 的组内，与低风险患者相比，高风险患者在 5 年研究期间的住院费用、就诊费用和药物费用分别为 89265 加元 vs 48374 加元（=0.008）、23423 加元 vs 11231 加元（<0.001）和 21853 加元 vs 16757 加元（=0.01）。在 eGFR 为 30-59ml/min/1.73m2 的组内，与低风险患者相比，高风险患者的住院费用、就诊费用和处方药费用分别为 55944 加元 vs 36740 加元（=0.10）、13414 加元 vs 10370 加元（=0.08）和 20394 加元 vs 14902 加元（=0.02），高风险患者的进展风险更高。
在多学科诊所中接受治疗的 eGFR 为 15-59ml/min/1.73m2 的 CKD 患者中，与低风险患者相比，KFRE 预测进展为肾脏衰竭风险更高的患者的住院费用、就诊费用和药物费用更高。在 eGFR 为 15-29ml/min/1.73m2 的 CKD 高风险患者组中，与住院费用、就诊次数和药物使用情况的关联更强。
