OBJECTIVES: The objective of the study was to evaluate the impact of kidney disease on people with diabetes and estimate the related costs and consequences in Portugal for a lifetime period.

METHODS: A Markov model, based on the KDIGO staging, and incorporating three additional stages (dialysis, kidney transplantation and death), was used to estimate survival, years lost due to disability (YLD), and costs incurred by diabetic patients with chronic kidney disease (CKD) throughout life. Clinical evolution was based on i) studies conducted in primary healthcare services, ii) data from the public Hospital Beatriz Ângelo and iii) Portuguese data of patients under renal replacement therapy. Costs were sourced from an expert panel, Portuguese primary care comprehensive administrative database, Diagnosis-Related Group (DRG) database, and other official data.

RESULTS: For very high-risk patients, it was estimated a life expectancy of 6.95 years, with 0.84 YLD, and a cost of 32.7 thousand euros. Regarding moderate-risk patients, it was estimated a life expectancy of 9.21 years, with 0.49 YLD, and a cost of 20.0 thousand euros per patient. For a low-risk patient, longer survival (10.54 years), lower YLD (0.42), and lower costs (18.1 thousand euros) were predicted. For the global population with CKD and diabetes, the model estimates a mean survival of 8.62 years, 0.59 YLD, and a mean cost CKD and diabetes of 24.6 thousand euros per patient. Overall, considering the entire cohort with CKD and diabetes, a loss of 410 thousand YDL and total cost of 17.0 thousand million euros was estimated.

CONCLUSIONS: This study is based on real world data, therefore reflecting national reality. The results show that disease progression is associated with worse results. Comparing very high-risk patients with low-risk, on average, life expectancy reduces 34%, YLD double and costs increase approximately by 81%.