Early-Stage Chronic Kidney Disease and Related Health Care Spending

This cohort study evaluates the association between early-stage chronic kidney disease and health care spending and its changes over time in Japan.

With adjustment; adjusted for age, sex, hypertension, and diabetes.
Excess healthcare spending is expressed as the difference in healthcare spending (US dollars) for each stage of CKD compared to the reference group (eGFR ≥60 mL/1.73m 2 and non-proteinuria).The error bars show 99% confidence intervals.Excess healthcare spending is expressed as the difference in healthcare spending (US dollars) for each stage of CKD compared to the reference group (eGFR ≥60 mL/min/1.73m 2 and non-proteinuria), adjusted for age, sex, hypertension, and diabetes.We estimated excess healthcare spending according to the subgroup by age (younger than 60 years and 60 years or older).The error bars show 99% confidence intervals.Excess healthcare spending is expressed as the difference in healthcare spending (US dollars) for each stage of CKD compared to the reference group (eGFR ≥60 mL/min/1.73m 2 and non-proteinuria), adjusted for age, hypertension, and diabetes.We estimated excess healthcare spending according to the subgroup by sex (female and male).The error bars show 99% confidence intervals.Excess healthcare spending is expressed as the difference in healthcare spending (US dollars) for each stage of CKD compared to the reference group (eGFR ≥60 mL/min/1.73m 2 and non-proteinuria), adjusted for age, sex, and hypertension.We estimated excess healthcare spending according to the subgroup by diabetes.The error bars show 99% confidence intervals.Excess healthcare spending is expressed as the difference in healthcare spending (US dollars) for each stage of CKD compared to the reference group (eGFR ≥60 mL/min/1.73m 2 and non-proteinuria), adjusted for age, sex, and diabetes.We estimated excess healthcare spending according to the subgroup by hypertension.The error bars show 99% confidence intervals.CKD: chronic kidney disease; eGFR: estimated glomerular filtration rate; G1-2: eGFR 60 mL/min/1.73m 2 or greater; G3a: eGFR 45-59 m/min/1.73m 2 ; G3b: eGFR 30-44 m/min/1.73m 2 ; A1 non-proteinuria; A2: proteinuria 1+, A3: proteinuria 2+ or greater.CKD: chronic kidney disease; eGFR: estimated glomerular filtration rate; G1-2: eGFR 60 mL/min/1.73m 2 or greater; G3a: eGFR 45-59 m/min/1.73m 2 ; G3b: eGFR 30-44 m/min/1.73m 2 ; A1 non-proteinuria; A2: proteinuria 1+, A3: proteinuria 2+ or greater.Excess incidence of hospitalization is expressed as the difference in the number of hospitalized days for each stage of CKD compared to the reference group (G1-2 & A1), adjusting for age, sex, hypertension, and diabetes.CKD: chronic kidney disease; eGFR: estimated glomerular filtration rate; G1-2: eGFR 60 mL/min/1.73m 2 or greater; G3a: eGFR 45-59 m/min/1.73m 2 ; G3b: eGFR 30-44 m/min/1.73m 2 ; A1 non-proteinuria; A2: proteinuria 1+, A3: proteinuria 2+ or greater.The bar graphs show the means of total healthcare spending in each decile across CKD stages.The table shows the median and interquartile range of total healthcare spending across CKD stages.The conversion from Japanese yen to US dollars was calculated using the rate on November 11, 2023 (1 US dollar = 149.03Japanese Yen).

eFigure 1 .
Excess Healthcare Spending at Baseline for Each CKD Stage Without Adjustment for Hypertension and Diabetes eFigure 2. Excess Healthcare Spending at Baseline for Each CKD Stage by Age eFigure 3. Excess Healthcare Spending at Baseline for Each CKD Stage by Sex eFigure 4. Excess Healthcare Spending at Baseline for Each CKD Stage by the Presence of Diabetes eFigure 5. Excess Healthcare Spending at Baseline for Each CKD Stage by the Presence of Hypertension eFigure 6. Progression of CKD Over 5 Years by Baseline CKD Stages eFigure 7. Excess Healthcare Spending for More Detailed CKD Stages eFigure 8. Excess Days of Outpatient Care for More Detailed CKD Stages eFigure 9. Excess Incidence of Hospitalization for More Detailed CKD Stages eFigure 10.Excess Use of Antihypertensive Drugs and Antidiabetic Drugs for Early-Stage CKD eFigure 11.Distribution of Total Healthcare Spending Across CKD Stages This supplemental material has been provided by the authors to give readers additional information about their work.eFigure 1. Excess Healthcare Spending at Baseline for Each CKD Stage Without Adjustment for Hypertension and Diabetes CKD: chronic kidney disease; eGFR: estimated glomerular filtration rate.Without adjustment; adjusted only for age and sex.

eFigure 2 .
Excess Healthcare Spending at Baseline for Each CKD Stage by Age CKD: chronic kidney disease; eGFR: estimated glomerular filtration rate.
eFigure 3. Excess Healthcare Spending at Baseline for Each CKD Stage by Sex CKD: chronic kidney disease; eGFR: estimated glomerular filtration rate.

eFigure 4 .
Excess Healthcare Spending at Baseline for Each CKD Stage by the Presence of Diabetes CKD: chronic kidney disease; eGFR: estimated glomerular filtration rate.

eFigure 5 .
Excess Healthcare Spending at Baseline for Each CKD Stage by the Presence of Hypertension CKD: chronic kidney disease; eGFR: estimated glomerular filtration rate.

eFigure 8 .
Excess Days of Outpatient Care for More Detailed CKD Stages Baseline: 2014; Year 1: 2015; Year 3: 2017; Year 5: 2019 Excess days of outpatient care is expressed as the difference in the number of days of outpatient care for each stage of CKD compared to the reference group (G1-2 & A1), adjusting for age, sex, hypertension, and diabetes.