Protein-energy wasting significantly increases healthcare utilization and costs among patients with chronic kidney disease: a propensity-score matched cohort study

Abstract

Background: Disease-related malnutrition is highly prevalent, and has prognostic implications for patients with chronic kidney disease (CKD); however, few studies have investigated the impact of malnutrition, or protein-energy wasting (PEW), on healthcare utilization and medical expenditure among CKD patients.

Methods: Using claim data from the National Health Insurance in Taiwan, this study identified patients with CKD between 2009–2013 and categorized them into those with mild, moderate, or severe CKD. Cases with PEW after CKD was diagnosed were propensity-score matched with controls in a 1:4 ratio. Healthcare resource utilization metrics were compared, including outpatient and emergency department visits, frequency and duration of hospitalization, and the cumulative costs associated with different CKD severity.

Results: From among 347,501 CKD patients, eligible cohorts of 66,872 with mild CKD (49.2%), 27,122 with moderate CKD (19.9%), and 42,013 with severe CKD (30.9%) were selected. Malnourished CKD patients had significantly higher rates of hospitalization (p < .001 for all severities) and re-admission (p = .015 for mild CKD, p = .002 for severe CKD) than non-malnourished controls. Cumulative medical costs for outpatient and emergency visits, and hospitalization, were significantly higher among all malnourished CKD patients than non-malnourished ones (p < .001); total medical costs were also higher among malnourished patients with mild (62.9%), moderate (59.6%), or severe (43.6%) CKD compared to non-malnourished patients (p < .001).

Conclusions: In a nationally-representative cohort, CKD patients with PEW had significantly more healthcare resource utilization and higher aggregate medical costs than those without, across the spectrum of CKD: preventing PEW in CKD patients should receive high priority if we would like to reduce medical costs.

Keywords:

• Chronic kidney disease
• emergency department
• end-stage renal disease
• healthcare utilization
• medical costs
• protein-energy wasting
• re-admission

Transparency

Declaration of funding

Abbott provided funding to support manuscript publication; however, this research work did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The funder has no role in the analysis, the interpretation of results, and discussion of this study.

Declaration of financial/other relationships

KYH has received grant funding and consultancy fees from Abbott Nutrition. RWYC and MYHW are employees of Abbott Nutrition; however, the information presented in this article is based on clinical evidence and is not influenced by any financial relationship. CHT and CTC have no relevant financial or non-financial competing interests to declare. CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

The authors thank Dr David Neil, of Content Ed Net (Taiwan), for his English editing services, which were funded by Abbott Laboratories Services Corp., Taiwan Branch.