Risk of Progression and Costs of Care for Patients With Chronic Kidney Disease.

Rationale & Objective: Chronic kidney disease (CKD) is associated with substantial economic burden. Early identification of high-risk patients with CKD can facilitate timely intervention and reduce CKD-related medical costs. This study assessed the association between CKD progression risk and health care burden. Study Design: Retrospective observational analysis. Setting and Participants: 1,050,552 adult US patients in Optum's electronic health records database between January 1, 2007 and September 30, 2022. Exposures: Risk of CKD progression as determined by a laboratory-based machine learning model. Outcomes: All-cause health care resource utilization and medical costs. Analytical Approach: A previously published and validated machine learning model, Klinrisk, was applied to classify patients into 3 groups based on their risk of CKD progression (low, medium, and high). All-cause inpatient admissions, emergency room (ER) visits, and outpatient visits were evaluated in each risk group for the 1 year after CKD diagnosis. Average medical costs (2023 US Dollars) were calculated as the average length of stay for inpatient admissions and average number of ER and outpatient visits multiplied by the corresponding unit costs as estimated from a prior study. Results: Patients with higher predicted CKD progression risk had higher health care burden. High-risk patients averaged 1.49 inpatient admissions, 0.83 ER visits, and 35.75 outpatient visits per year compared with 0.31 inpatient admissions, 0.63 ER visits, and 24.45 outpatient visits among low-risk patients. The total annual medical costs for low-, medium-, and high-risk patients were $16,018, $22,090, and $50,218, respectively. Limitations: Our analysis only considered direct medical costs to the payer and omitted indirect costs (eg, transportation, capital, health records). The Klinrisk model only predicts CKD progression, not cardiovascular disease outcomes. Conclusions: Patients at high risk of CKD progression as predicted by the Klinrisk model had higher health care resource utilization and medical costs and may benefit from medical intervention and care management to reduce economic burden.