Prevalence, outcomes, and cost of chronic kidney disease in a contemporary population of 2·4 million patients from 11 countries: The CaReMe CKD study

Johan Sundström; Johan Bodegard; Andreas Bollmann; Marc G Vervloet; Patrick B Mark; Avraham Karasik; Tiago Taveira-Gomes; Manuel Botana; Kåre I Birkeland; Marcus Thuresson; Levy Jäger; Manish M Sood; Gijs VanPottelbergh; Navdeep Tangri; CaReMe CKD Investigators

doi:10.1016/j.lanepe.2022.100438

Prevalence, outcomes, and cost of chronic kidney disease in a contemporary population of 2·4 million patients from 11 countries: The CaReMe CKD study

Lancet Reg Health Eur. 2022 Jun 30:20:100438. doi: 10.1016/j.lanepe.2022.100438. eCollection 2022 Sep.

Authors

Johan Sundström^{1

2}, Johan Bodegard³, Andreas Bollmann⁴, Marc G Vervloet⁵, Patrick B Mark⁶, Avraham Karasik⁷, Tiago Taveira-Gomes⁸, Manuel Botana⁹, Kåre I Birkeland^{10

11}, Marcus Thuresson¹², Levy Jäger¹³, Manish M Sood¹⁴, Gijs VanPottelbergh¹⁵, Navdeep Tangri¹⁶; CaReMe CKD Investigators

Affiliations

¹ Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
² The George Institute for Global Health, University of New South Wales, Sydney, Australia.
³ Cardiovascular, Renal and Metabolism, Medical Department, BioPharmaceuticals, AstraZeneca, Oslo, Norway.
⁴ Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany.
⁵ Amsterdam UMC, Department of Nephrology, Amsterdam, the Netherlands.
⁶ Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
⁷ Maccabi Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel.
⁸ Department of Community Medicine, Information and Decision in Health, Faculty of Medicine, University of Porto, Portugal.
⁹ University Hospital Lucus Augusti, Lugo, Spain.
¹⁰ Department of transplantation medicine, Oslo University Hospital, Oslo, Norway.
¹¹ University of Oslo, Oslo, Norway.
¹² Statisticon AB, Uppsala, Sweden.
¹³ Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland.
¹⁴ Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
¹⁵ Department of Public Health and Primary Care, KUleuven, Belgium.
¹⁶ Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Canada.

Abstract

Background: Digital healthcare systems data could provide insights into the global prevalence of chronic kidney disease (CKD). We designed the CaReMe CKD study to estimate the prevalence, key clinical adverse outcomes and costs of CKD across 11 countries.

Methods: Individual-level data of a cohort of 2·4 million contemporaneous CKD patients was obtained from digital healthcare systems in participating countries using a pre-specified common protocol; summarized using random effects meta-analysis. CKD and its stages were defined in accordance with current Kidney Disease: Improving Global Outcomes (KDIGO) criteria. CKD was defined by laboratory values or by a diagnosis code.

Findings: The pooled prevalence of possible CKD was 10·0% (95% confidence interval 8.5‒11.4; mean pooled age 75, 53% women, 38% diabetes, 60% using renin-angiotensin-aldosterone system inhibitors). Two out of three CKD patients identified by laboratory criteria did not have a corresponding CKD-specific diagnostic code. Among CKD patients identified by laboratory values, the majority (42%) were in KDIGO stage 3A; and this fraction was fairly consistent across countries. The share with CKD based on urine albumin-creatinine ratio (UACR) alone (KDIGO stages one and two) was 29%, with a substantial heterogeneity between countries. Adverse events were common; 6·5% were hospitalized for CKD or heart failure, and 6·2% died, annually. Costs for renal events and heart failure were consistently higher than costs for atherosclerotic events in CKD patients across all countries.

Interpretation: We estimate that CKD is present in one out of ten adults. These individuals experience significant adverse outcomes with associated costs. The prevalence of CKD is underestimated when using diagnostic codes alone. There is considerable public health potential in diagnosing CKD and providing treatments to those currently undiagnosed.

Funding: The study was sponsored by AstraZeneca.

Keywords: Chronic kidney disease; Costs; Epidemiology; Global health; Outcomes; Prevalence; Primary care; Public health; Renal impairment.