Abstract: SA-PO147
Disease Characteristics and Outcomes in Patients with CKD and Type 2 Diabetes: A Matched Cohort Study of Spironolactone Users and Non-Users
Session Information
- Diabetic Kidney Disease: Clinical - II
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Diabetic Kidney Disease
- 602 Diabetic Kidney Disease: Clinical
Authors
- Blankenburg, Michael, Bayer Pharma AG, Berlin, Germany
- Kovesdy, Csaba P., University of Tennessee Health Science Center, Memphis, Tennessee, United States
- Fett, Anne-Kathrin, QuintilesIMS, Frankfurt, Germany
- Schokker, Emile, IQVIA, Frankfurt, Germany
- Gay, Alain, Bayer, BERLIN, Germany
Background
This study aimed to assess disease characteristics and outcomes in cohorts of spironolactone users and non-users with chronic kidney disease (CKD) and type 2 diabetes (T2D) who were matched on demographic and clinical characteristics, including CKD stage.
Methods
Patients with CKD and T2D were identified in the US claims database PharMetrics Plus using ICD-9 and ICD-10 codes. Outcomes of interest including CKD progression, clinical events, healthcare use and costs were described in the matched cohorts using summary statistics; mortality analyses were conducted in a sub-cohort with linkable data in Experian. The impact of persistent or non-persistent spironolactone use (≥6 vs. <6 months treatment duration) was also evaluated.
Results
The matched cohorts (n=5,465 each) both had a median age of 62 years and 61% of patients were male. Despite matching, spironolactone users had more comorbidities at baseline than non-users (Charlson comorbidity index score 4+, 89% vs. 78%). During one-year of follow-up, progression to a more severe CKD stage occurred in 30% of spironolactone users and 18% of non-users. Annual median healthcare costs per person were $33,013 for spironolactone users and $22,598 for non-users; 62% and 50% of patients had at least one inpatient visit, respectively. The mortality rate per person-year was 4% for spironolactone users and 7% for non-users; however, the mortality rate assessment was conducted in a younger sub-cohort with lower rates of heart failure (n=1,431 each). Persistent spironolactone users had fewer clinical events, lower healthcare use and costs and a reduced likelihood of CKD progression than non-persistent users.
Conclusion
In this study, spironolactone users were more severely ill, had worse clinical outcomes and higher healthcare use and costs than non-users. These findings highlight the unmet medical need in this patient population and the need for better treatment options.
Funding
- Commercial Support – Bayer AG