Abstract: TH-PO993
Screening for Urine Protein as a Risk Factor for ESRD Using a Large Claims Database
Session Information
- CKD Epidemiology, Risk Factors, Prevention - I
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Dhawan, Rahul, Optum Inc, Eden Prairie, Minnesota, United States
- Crossman, Ashley, Optum Inc, Eden Prairie, Minnesota, United States
- Latts, Lisa M., Optum Inc, Eden Prairie, Minnesota, United States
- Wysocky, Gregory, Optum Inc, Eden Prairie, Minnesota, United States
Group or Team Name
- Optum Kidney Solutions: Nurses, Product Team and the OHS Medical Office Team.
Background
Proteinuria screening serves as a crucial diagnostic tool in identifying chronic kidney disease (CKD) and mitigating the risk of progression to end-stage renal disease (ESRD). Timely detection and intervention can enhance patient outcomes and provide cost savings, as proteinuria serves as a predictor for ESRD and all-cause mortality rates.
Methods
A large health insurance claims database was used to analyze the relationship between estimated glomerular filtration rate (eGFR), urine albumin-creatinine ratio (uACR), and the progression to ESRD in a population of Medicare members with CKD stages 3a to ESRD during the index month of January 2021. The analysis included data from the 12 months prior to the index month to determine the presence or absence of proteinuria and data from the 12 months following the index month to determine ESRD transition. Data from 32,194 individuals was included. Sources included Medicare claims, labs, and demographics.
Results
Of the 32,194 members in this analysis, 47% were female and the average age was 57.3 years. Thirty-six percent of individuals who had eGFR stage G5 and A3 (severely increased) degree of proteinuria in the twelve months starting January 2021 progressed to ESRD. Twenty-three percent of individuals with eGFR stage G5 patients without proteinuria screening progressed to ESRD. Eighteen percent of the population had proteinuria screening and 22.9% of these patients were CKD 3B, 12.1% were stage 4, and 13.8% were stage 5. Of these patients, 26% were A3, 42% were A2 (Moderately increased) and 32% were A1 (Normal to mildly increased).
Conclusion
Proteinuria screening can provide an early warning of CKD that may progress to ESRD and potentially allow for risk mitigation. In this analysis, more than one-third of CKD G5A3 patients progressed to dialysis within a year. Prompt detection of patients with proteinuria and management, coupled with adherence to ACE and SGLT2 inhibitors, may curtail progression. Utilizing a health plan database is a useful tool to identify individuals who have proteinuria and are at risk of CKD progression and earlier diagnosis can lead to improved outcomes and delay in CKD progression.