COMMENTARY

CKD and CVD Hit Healthcare Pocketbook and Patients With T2D Hard

Gregory A. Nichols, PhD

Disclosures

August 02, 2019

This transcript has been edited for clarity.

My name is Greg Nichols. I'm a senior investigator at the Kaiser Permanente Center for Health Research. Yesterday afternoon, I presented a paper on the costs associated with cardiovascular disease and chronic kidney disease in patients with diabetes.[1] We divided people into four groups, including people with diabetes and neither chronic kidney disease nor cardiovascular disease, a group with each of those conditions alone, and then a fourth group with both chronic kidney disease and cardiovascular disease.

Interestingly, we found that if a patient had chronic kidney disease, costs were about twice as high as patients with neither chronic kidney disease nor cardiovascular disease. Patients with cardiovascular disease had costs that were a little more than twice as high.

Those two factors were additive. When patients had both cardiovascular disease and chronic kidney disease, their costs were four times greater and almost exactly the sum of those of patients with just cardiovascular disease or just chronic kidney disease.

I thought that was really interesting, and what drives those costs is inpatient care, particularly cardiovascular hospitalizations. Even for patients without cardiovascular disease at baseline, in the subsequent year, 10%-15% of their admissions had a first-listed diagnosis of cardiovascular disease.

In this study, we also looked at costs of patients across stages of chronic kidney disease. As you would probably expect, they increase exponentially from mild impairment of kidney function to end-stage kidney disease. Again, those costs are strongly driven by inpatient care. Even in patients with end-stage kidney disease, about one third of the costs are for inpatient care, which accounts for huge costs associated with dialysis.

The triple aim in healthcare describes how we would like to provide the best possible quality experience for individual patients while improving population health at the lowest possible costs. Our results suggested that if we can treat patients to prevent hospitalizations—in particular, cardiovascular disease hospitalizations—and prevent the onset and progression of kidney disease, it would help achieve the triple aim.

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