OBJECTIVES: Chronic kidney disease (CKD) is a common public health problem in China, and the prevalence of CKD is 10.8% with 1.7% in pre-dialysis phase. In addition, the costs are estimated to be 643 billion CNY per year for CKD patients in pre-dialysis phase. The objective of this study was to identify factors impacting direct costs of CKD among Chinese urban patients in pre-dialysis phase.

METHODS: Patients were recruited in China’s four metropolises, Beijing (the capital city), Shanghai (in East China), Guangzhou (in South China), and Chengdu (in West China). The study sample consisted of 281 patients in Stage 3 or 4 of CKD, the pre-dialysis phase. For each patient, direct costs included costs of outpatient visits, hospitalization, prescription drugs, labs, and physical therapies. An ordinary least squares regression model was conducted, with direct costs being the dependent variable. Independent variables were gender, age, insurance status, education level, income level, metropolis (four metropolises, Beijing as the reference group), cause of CKD (ten categories, chronic glomerulonephritis as the reference group), history of CKD, and quality of life (EQ-5D index score, China weight). Quality of life was obtained during interviews with patients or their caregivers.

RESULTS: The regression model was significant (P=0.001), and explained 17% of the variance. The significant predictors (P<0.05) of direct costs were metropolis (Chengdu) and cause of CKD (chronic glomerulonephritis and hypertensive renal disease, diabetic kidney disease and hypertensive renal disease, uremia, and other causes). In addition, metropolis (Chengdu) was a strong positive predictor, whereas the predictive effect of cause of CKD was small.

CONCLUSIONS: Compared with patients in Beijing, patients in Chengdu had significantly higher direct costs. This finding implies health disparity of CKD patients between the two metropolises. Future studies are needed to explore how to reduce such regional disparity.