Chronic kidney disease (CKD) is a disease that often exists with other long-term diseases and constitutes an increasing burden on healthcare resources globally and in England. Effective management of CKD improves the health of the affected individuals and reduces the impact on the nation's healthcare resources. What remains unclear is the effect of these long-term conditions on the worsening of the state of those already affected with CKD or a potential to cause the CKD among those that may be prone to developing the disease, such as individuals with type 2 diabetes mellitus. Therefore, this study aims to describe and analyse how adult patients with CKD get worse over time. Also, we plan to characterise the individuals that live with the condition and those that newly develop it yearly, understand what other long-term conditions they may have, how often they visit hospitals or use healthcare services, and perhaps the number of deaths that occur among the CKD sufferers.
A large database, the Clinical Practice Research Datalink (CPRD) AURUM database, will be linked to other patient digital databases such as Hospital Episode Statistics (HES) and Index of Multiple Deprivations (IMD) databases, will be used. Proportions and characteristics of the patients living with CKD, their stages, and associated long-term conditions will be presented for ten years. Also, an overview of how CKD worsens over time, how many of those affected with CKD often use public resources and the associated costs, and what other conditions often occur to them will be established.
CKD is a significant public health concern that often exists in combination with other major chronic diseases. It is associated with worse clinical outcomes and increased healthcare resource utilisation. Optimising CKD management is associated with improved clinical outcomes. However, a better understanding of the impact of the co-morbidities on the progression and incidence of CKD in England is required.
The study therefore aims to :
1. Characterise the CKD patient population with respect to demographics and baseline clinical characteristics, and estimate the incidence and prevalence of CKD in the overall English adult population.
2. Quantify the rates of CKD-related outcomes among patients with CKD and identify the patient characteristics associated with the progression of CKD at two years and five years.
3. Estimate rates of CKD-related medication use and frequency of guideline-recommended renal laboratory testing in patients with CKD and among patients at high risk for CKD.
4. Estimate healthcare resource utilisation and costs in patients with CKD.
CPRD AURUM database will be used to establish a cohort of patients with CKD from January 2010 to December 2019. CKD diagnosis will be based on eGFR thresholds. Relevant CKD events, and healthcare resource use will be estimated from linked Hospital Episode Statistics (HES) admitted patient care (APC), HES outpatient care, deprivation statistics, and Office of National Statistics (ONS). Annual incidence and prevalence of CKD will be estimated and event rates will be presented per 1000PY. Least Absolute Shrinkage and Selection Operator (LASSO) regression will be used to identify the individual characteristics associated with the eGFR slope. eGFR slope will be calculated using a generalised linear model.
Main outcomes include:
Estimated glomerular filtration (eGFR) slopes and worsening states, prevalence, all-cause mortality, rates of hospitalisations,CV mortality, CKD medication use and testing rates.
Results will inform healthcare resource allocation plans and disease burden management.
Primary outcomes:
eGFR slopes, KDIGO eGFR worsening states, prevalence and incidence, all-cause mortality, all-cause hospitalisation, Cardiovascular (CV) death, hospitalisation for heart failure, proportions and absolute numbers for CKD testing and CKD medication use
Secondary outcomes:
CVD co-morbidities counts and rates (per 1000 person year)
End stage renal events counts and rates (per 1000 person year)
Fractures events counts and rates (per 1000 person year)
Metabolic events events counts and rates (per 1000 person year)
Cancers events counts and rates (per 1000 person year)
Infections events counts and rates (per 1000 person year)
Remi Popoola - Chief Investigator - Boehringer Ingelheim Limited
Remi Popoola - Corresponding Applicant - Boehringer Ingelheim Limited
Christina Shay - Collaborator - Boehringer-Ingelheim Pharmaceuticals, Inc
Ling Zhang - Collaborator - Boehringer-Ingelheim Pharmaceuticals, Inc
Louise Muttram - Collaborator - Boehringer Ingelheim Limited
Paul Cockwell - Collaborator - University Hospitals Birmingham
Ruth Farmer - Collaborator - Boehringer-Ingelheim Pharmaceuticals, Inc
HES Admitted Patient Care;HES Outpatient;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation