Data Scientist Odysseus Data Services Inc. Richmond, United States
Background: Patients with chronic kidney disease (CKD) have high burden and suboptimal outcomes. The addition of heart failure (HF) in patients with CKD contributes to worse outcomes including progression to end stage kidney disease (ESKD). Targeted pharmacological management of patients with CKD and HF can improve patients’ outcomes.
Objectives: This study aims to describe characteristics and clinical outcomes of patients with CKD with prior HF (CKD-HF+) and no prior HF (CKD-HF-).
Methods: Data from nationwide claims (Optum Claims, Truven MarketScan) and electronic health records (EHRs) (Optum EHR) standardized to the OMOP CDM were used to identify patients newly diagnosed with CKD (index date) with at least one HF diagnosis one year prior to the index date. The study timeframe spanned from 2010 to 2020. Characteristics of patients and the incidence per 100 person-years of clinical outcomes were described.
Results: The study identified 8.4 million patients with CKD-HF- (2.8m in Optum EHR, 3.4m in Optum Claims, and 2.2m in MarketScan) and 0.4 million patients with CKD-HF+ (0.1m in Optum EHR, 0.1m in Optum Claims and 0.2m in MarketScan). CKD-HF+ patients were older: median age of 72-75 compared to 62-71 years in CKD-HF- patients. Almost 50% of patients with CKD-HF+ and CKD-HF- were male across all databases. Patients with CKD-HF- had longer follow up time, ranging from a median of 571 to 894 days, compared to CKD-HF+ patients, whose median time ranged from 548 to 729 days. Cardiovascular comorbidities were higher in CKD-HF+ patients; such as atrial fibrillation ranging from 27-39% in patients with CKD-HF+ compared to 12-17% in patients with CKD-HF- and coronary artery disease ranging from 90-93% compared to 43-54%. Higher rates of ESKD and hospitalization due to HF were observed in patients with CKD-HF+ compared to patients with CKD-HF- across all databases: 19 vs 11 in Optum EHR, 21 vs 17 in MarketScan and 12 vs 6 in Optum Claims for ESKD and 17 vs 6 in Optum EHR, 13 vs 6 in MarketScan and 12 vs 6 in Optum Claims for HF hospitalization. Patients with CKD-HF+ had higher medication burden after index which included guideline recommended drug classes like MRAs (utilization ranging from 2-3% prescribed to patients with CKD-HF- vs 3-5% to patients with CKD-HF+), and beta blockers (utilization ranging from 13-23% prescribed to patients with CKD-HF- vs 17-29% to patients with CKD-HF+)
Conclusions: This largescale network study demonstrates the substantial burden HF adds to patients with CKD who are also at greater risk for clinical outcomes such as ESKD and hospitalization due to HF. The low utilization of guideline recommended therapies also highlights a need for targeted treatment strategies to optimally manage these patients and improve their outcomes.
