Comorbidities As a Risk Predictor of Kidney Disease Progression Among Patients Diagnosed With Chronic Kidney Disease
Author(s)
Chengan Du, PhD1, Kevin F. Erickson, MD, PhD2, Ben Modley, MSc3, Wolfgang C. Winkelmayer, MD, PhD2, James B. Fotheringham, MD, PhD4, Ling Zhang, MPH, MS, MD1, Dominik Steubl, MD5, Villum Wittrup-Jensen, MSc, PhD5, Ron Akehurst, PhD6.
1Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA, 2Baylor College of Medicine, Houston, TX, USA, 3leads.healthcare, Staufen im Breisgau, Germany, 4University of Sheffield, Sheffield, United Kingdom, 5Boehringer Ingelheim Intl. GmbH & Co. KG, Ingelheim am Rhein, Germany, 6Lumanity, Sheffield, United Kingdom.
1Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA, 2Baylor College of Medicine, Houston, TX, USA, 3leads.healthcare, Staufen im Breisgau, Germany, 4University of Sheffield, Sheffield, United Kingdom, 5Boehringer Ingelheim Intl. GmbH & Co. KG, Ingelheim am Rhein, Germany, 6Lumanity, Sheffield, United Kingdom.
OBJECTIVES: Today is it widely accepted, among most healthcare regulatory bodies and health technology assessment institutes (HTAs), that estimated glomerular filtration rate (eGFR) decline, is a predictor of chronic kidney disease (CKD) disease progression, yet less is known about how eGFR is associated with adverse outcomes and, especially the presents of co-morbidities, such as type 2 diabetes, hypertension and cardiovascular diseases, and how co-morbidities impact the incidence accounting for the incremental risk of these adverse outcomes among CKD patients.
METHODS: Using the US Optum Market Clarity database (January 2017 - June 2024), we identified adult CKD patients with ≥2 eGFR values <90 mL/min/1.73 m² within one year and ≥90 days apart. The first qualifying eGFR was the index date. Comorbidities were assessed within 6 months prior. Patients having ≥1 eGFR per year during at least 2 and up to 3-year follow-up time were included. Having sustained ≥40% decline in eGFR pair during follow up time was captured as outcome. Event rates of 40% decline were estimated in three cohorts: CKD-only patients, CKD+HTN+CVD including CKD patients with hypertension (HTN) and cardiovascular disease (CVD); and CKD+HTN+CVD+T2D including CKD patients with HTN, CVD and type 2 diabetes (T2D). Odd ratios with 95% confidence intervals (ORs(90%CI)) were provided using logistic regression analyses.
RESULTS: Among 135,364 CKD-only, 251,865 CKD+HTN+CVD patients, and 237,669 CKD+HTN+CVD+T2D patients, the event rates of sustained ≥40% eGFR decline were 12.49%, 14.52%, and 21.28%, respectively. Mean follow-up was approximately 2.74 years across cohorts. Using the CKD-only group as reference, ORs (90% CI) were 1.19 (1.17-1.21) for CKD+HTN+CVD and 1.89 (1.86-1.93) for CKD+HTN+CVD+T2D.
CONCLUSIONS: Patients with CKD and who also have multiple co-morbidities, face a significantly higher risk of eGFR decline. These findings highlight the unmet need to tailor disease management strategies for the growing population of multimorbid CKD patients.
METHODS: Using the US Optum Market Clarity database (January 2017 - June 2024), we identified adult CKD patients with ≥2 eGFR values <90 mL/min/1.73 m² within one year and ≥90 days apart. The first qualifying eGFR was the index date. Comorbidities were assessed within 6 months prior. Patients having ≥1 eGFR per year during at least 2 and up to 3-year follow-up time were included. Having sustained ≥40% decline in eGFR pair during follow up time was captured as outcome. Event rates of 40% decline were estimated in three cohorts: CKD-only patients, CKD+HTN+CVD including CKD patients with hypertension (HTN) and cardiovascular disease (CVD); and CKD+HTN+CVD+T2D including CKD patients with HTN, CVD and type 2 diabetes (T2D). Odd ratios with 95% confidence intervals (ORs(90%CI)) were provided using logistic regression analyses.
RESULTS: Among 135,364 CKD-only, 251,865 CKD+HTN+CVD patients, and 237,669 CKD+HTN+CVD+T2D patients, the event rates of sustained ≥40% eGFR decline were 12.49%, 14.52%, and 21.28%, respectively. Mean follow-up was approximately 2.74 years across cohorts. Using the CKD-only group as reference, ORs (90% CI) were 1.19 (1.17-1.21) for CKD+HTN+CVD and 1.89 (1.86-1.93) for CKD+HTN+CVD+T2D.
CONCLUSIONS: Patients with CKD and who also have multiple co-morbidities, face a significantly higher risk of eGFR decline. These findings highlight the unmet need to tailor disease management strategies for the growing population of multimorbid CKD patients.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
RWD37
Topic
Real World Data & Information Systems
Topic Subcategory
Health & Insurance Records Systems
Disease
Urinary/Kidney Disorders