Presentation (CTI)

OBJECTIVES: Chronic kidney disease (CKD) affects ~35.5 million Americans and poses multiple comorbidity risks. Primary liver cancer (LC) is also common, with ~40,000 new cases in the US last year; liver metastasis are common. Gadolinium-based contrast agents (GBCAs) enhance diagnostic imaging for cancer patients but carry a black box warning for patients with severe CKD or acute kidney injury (AKI) due to the risk of nephrogenic systemic fibrosis. This study evaluated burden of illness, imaging, and healthcare resource utilization in patients with primary or secondary LC and CKD or AKI.
METHODS: This retrospective, cross-sectional study analyzed enrollee-level US claims in Medicare FFS and Marketscan datasets over 24 months. Six cohorts (C1-6) were determined by cancer diagnosis (primary/secondary LC, other cancers (OC)) and CKD grades (4 and 5), or AKI, within the enrollment period. The analysis compared demographics and medical/prescription claims.
RESULTS: The study identified 230,000 patients, including 450 in C1 (LC+CKD), 2,816 in C3 (LC+AKI), 4,202 in C2 (OC+CKD), 26,956 in C4 (OC+AKI), 8,528 in C5 (LC) and 187,048 in C6 (OC). Comorbidities were more prevalent in C1 and C3, where 92% and 71% had hypertension, 84% and 82% had liver disease/cirrhosis, and 53% and 40% had hyperlipidemia, respectively. Patients in C1 and C3 underwent more abdominal imaging than others, with up to 7 procedures over the study period. Despite the black box warning, approximately 30% of Medicare and 50% of Commercial patients in C1 received MRI with GBCAs. Overall, patients in C1 and C3 incurred higher medical costs than OC; the median commercial paid amount over the study period was $231K C1, $321K C3, and ~$120K C2-C4, respectively.
CONCLUSIONS: This study highlights the substantial burden of illness and vulnerability of patients with LC and CKD or AKI, emphasizing the urgent and unmet need for safer imaging modalities without black-box warnings.