https://orcid.org/0000-0003-3678-0208
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Abstract
Introduction
Type 2 diabetes mellitus (T2DM) is a leading cause of chronic kidney disease (CKD) globally. Both conditions substantially worsen patients’ prognosis. Current data on German in-hospital CKD cohorts are scarce. The multinational CaReMe study was initiated to evaluate the current epidemiology and healthcare burden of cardiovascular, renal and metabolic diseases. In this substudy, we share real-world data on CKD inpatients stratified for coexisting T2DM derived from a large German hospital network.
Methods
This study used administrative data of inpatient cases from 89 Helios hospitals from 01/01/2016 to 28/02/2022. Data were extracted from ICD-10-encoded discharge diagnoses and OPS-encoded procedures. The first case meeting a previously developed CKD definition (defined by ICD-10- and OPS-codes) was considered the index case for a particular patient. Subsequent hospitalizations were analysed for readmission statistics. Patient characteristics and pre-defined endpoints were stratified for T2DM at index case.
Results
In total, 48,011 patients with CKD were included in the present analysis (mean age ± standard deviation, 73.8 ± 13.1 years; female, 44%) of whom 47.9% had co-existing T2DM. Patients with T2DM were older (75 ± 10.6 vs 72.7 ± 14.9 years, p < 0.001), but gender distribution was similar to patients without T2DM. The burden of cardiovascular disease was increased in patients with T2DM, and index and follow-up in-hospital mortality rates were higher. Non-T2DM patients were characterised by more advanced CKD at baseline. Patients with T2DM had consistently higher readmission numbers for all events of interest, except for readmissions due to kidney failure/dialysis, which were more common in non-T2DM patients.
Conclusion
In this study, we present recent data on hospitalized patients with CKD in Germany. In this CKD cohort, nearly half had T2DM, which substantially affected cardiovascular disease burden, rehospitalization frequency and mortality. Interestingly, non-diabetic patients had more advanced underlying renal disease, which affected renal outcomes.
Graphical Abstract
Abbreviations
AKI, acute kidney injury; CI, confidence interval; CKDopps, Chronic Kidney Disease Outcomes and Practice Patterns Study; CVD, cardiovascular diseases; DKD, diabetic kidney disease; GCKD, German Chronic Kidney Disease study; eGFR, estimated glomerular filtration rate; FU, follow-up; ICD-10-GM, International Statistical Classification of Diseases and Related Health Problems Version 10, German Modification; NDKD, non-diabetic kidney disease; OPS, Operation and Procedure classification system; OR, odds ratio; T2DM, Type 2 diabetes mellitus.
Data Sharing Statement
Helios Health and Helios Hospitals have strict rules regarding data sharing because health claims data are a sensible data source and have ethical restrictions imposed due to privacy concerns. Access to anonymised data supporting the findings of this study is available on request from the Helios Health Institute (www.helios-health-institute.com). Please direct queries to the data protection officer (Email: [email protected]) and refer to the study “CaReMe CKD”.
Statement of Ethics
The analysis was conducted according to the principles outlined in the Declaration of Helsinki. Patient-related data were stored in an anonymised form. The local ethics committee (vote: AZ 010/21-ek) and the Helios Kliniken GmbH data protection authority approved data use for this study.
Acknowledgments
The authors thank PD Dr Max Lennart Eckstein, Dr Jakob Birnbaum, Dr Marlena Müller for their help with content support while conducting this study. We also thank Dr Celina M. Gollop, Pia Schmitz and Konstantinos Mouratis for their help concerning project management.
Author Contributions
All named authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.
Disclosure
The Helios Health Institute has a research cooperation with AstraZeneca Germany. AstraZeneca financially supported the analyses underlying this publication. No authors received any personal payment nor is any employee of the Helios Health Institute (financially) related to AstraZeneca. The authors report no other conflicts of interest in this work.