Assessing Clinical and Economic Burden of Renal Replacement Therapies Patients With Diabetes in South Korea

OBJECTIVES: Diabetes is one of the most common causes of chronic kidney disease (CKD). Renal replacement therapy (RRT) represents the most severe stage of CKD, more than half of RRT patients have comorbid diabetes. This study aims to investigate the clinical characteristics and estimate medical expenditures of RRT patients with diabetes.

METHODS: We conducted a prevalence-based cross-sectional study using a sample of 1.1 million patients, representing 3% of the total population of South Korea. RRT patients were defined as those diagnosed with hemodialysis (HD; O7020, O7021, O9991 of procedure codes), peritoneal dialysis (PD; O7076, O7077), or kidney transplantation (KT; R3280) at least once per year. The study examined patients’ characteristics, healthcare resource utilization, and medical expenditure in RRT patients with diabetes.

RESULTS: The distribution of RRT patients increased with age, with 34.9% being over 70 years old and 29.5% in their 60s. 62.1% of the patients were male. Over 80% of RRT patients had hyperlipidemia, and over 90% had hypertension. Approximately two-thirds of the patients had been hospitalized, with an average about four hospitalizations annually and an average length of stay of 54.8 days. The annual average medical expenditure for RRT patients with diabetes was €20,078.21. KT had the highest treatment costs (€25,441), and HD had the highest frequency of outpatient visits (103.78).

CONCLUSIONS: The clinical and economic burden of RRT patients with comorbid diabetes was estimated to be substantial. Furthermore, since the patients are elderly and have other chronic diseases, integrated management is necessary. Future research should investigate the incremental impact of comorbid chronic diseases on medical expenditure in RRT patients.