Health Care Use, Cost High for Patients With Undiagnosed CKD

Many patients do not realize they have chronic kidney disease (CKD) despite having laboratory values that support the diagnosis. Rena Moon and others studied this problem and presented results during the National Kidney Foundation Spring Clinical Meetings 2024.

The researchers examined inpatient and outpatient discharge data from more than 1200 US hospitals to comprehend CKD status (diagnosed, undiagnosed, and at risk) and to measure the prevalence and burden of patients whose CKD was not diagnosed.

Participants were adults with an inpatient or outpatient visit during 2017-2021 with ≥1 serum creatinine (Cr) measurement and an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m² or albuminuria (urine albumin-to-Cr ratio >30 mg/g). The researchers defined CKD stage ≥3 per Kidney Disease Improving Global Outcomes criteria: ≥2 eGFR <60 or albuminuria ≥3 months apart, or CKD-related diagnosis/procedure codes between 12 months prior to and 12 months after the index visit.

There were 2,847,086 eligible patients, 50% (n=1,422,492) of whom had CKD; 31% (n=440,749) had no diagnosis of CKD despite meeting the clinical criteria for CKD. More White patients (78% vs 72%) and female patients (63% vs 45%) were undiagnosed versus diagnosed. Most undiagnosed patients had CKD stage 3 (82%) and ≥1 comorbidity; 67% had hypertension, 46% hyperlipidemia, and 31% diabetes. This population had a high frequency of annual all-cause hospitalizations (26%), intensive care unit admissions (10%), and emergency department visits (43%). Their mean all-cause annual health care cost was $15,196 per patient.

The large proportion of patients whose CKD was undiagnosed despite having visited a medical provider points to the need for improved screening, diagnosis, and treatment. New educational and outreach materials and clinical decision support are merited.

Source: Moon R, Rosenthal N, Desai P, et al. Uncovering the burden of undiagnosed chronic kidney disease in US healthcare systems. Presented at the National Kidney Foundation Spring Clinical Meetings 2024; May 14-18, 2024; Long Beach, California.