End-stage renal disease in autosomal dominant polycystic kidney disease: a comparison of dialysis-related utilization and costs with other chronic kidney diseases

Figures & data

Table 1 Demographic characteristics of analytical cohorts

	Overall (N=79,927)	Control (n=3,822)	ADPKD (n=1,274)
Age, years
Mean (SD)	62.4 (15.5)	62.8 (15.4)	55.7 (13.0)
Median (IQR)	64 (52–74)	64 (53–75)	54 (46–64)
Range	18–109	18–97	19–89
Sex, n (%)
Female	34,873 (43.6)	1,645 (43.0)	612 (48.0)
Male	45,051 (56.4)	2,177 (57.0)	662 (52.0)
Race/ethnicity, n (%)
Caucasian	39,979 (50.0)	1,895 (49.6)	901 (70.7)
African-American	23,266 (29.1)	1,134 (29.7)	175 (13.7)
Hispanic	10,880 (13.6)	515 (13.5)	121 (9.5)
Other	1,736 (2.2)	276 (7.2)	77 (6.0)
Access/modality, n (%)
Catheter	62,696 (78.4)	2,959 (77.4)	666 (52.3)
Fistula	10,759 (13.5)	542 (14.2)	401 (31.5)
Graft	2,868 (3.6)	154 (4.0)	52 (4.1)
Peritoneal dialysis	3,336 (4.2)	151 (4.0)	155 (12.2)
Unknown	268 (0.3)	16 (0.4)	0 (0.0)
Post-dialysis weight, kg
Mean (SD)	81.3 (23.0)	81.5 (22.7)	81.2 (22.8)
Median (IQR)	77.6 (65.2–93.4)	77.8 (65.5–93.3)	76.9 (65.0–93.8)
Range	26–305	30–236	33–196
Body mass index, kg/m^2
Mean (SD)	28.4 (7.5)	28.5 (7.5)	27.5 (7.1)
Median (IQR)	27.0 (23.2–32.1)	27.1 (23.3–32.2)	25.9 (22.7–30.9)
Range	8.6–120	13.1–70.4	14.5–96.4
Diabetes, n (%)	29,550 (37.0)	1,438 (37.6)	132 (10.4)
Heart failure, n (%)	13,386 (16.8)	617 (16.1)	76 (6.0)
Coronary disease, n (%)	8,155 (10.2)	419 (11.0)	101 (7.9)
Cerebrovascular disease, n (%)	3,643 (4.6)	176 (4.6)	37 (2.9)
Charlson Comorbidity Index
Mean (SD)	5.0 (1.7)	5.1 (1.7)	3.5 (1.4)
Median (IQR)	5 (4–6)	5 (4–6)	3 (2–4)
Range	2–19	2–12	2–19
Primary payer, n (%)
Medicare primary	42,141 (52.7)	2,196 (57.5)	420 (33.0)
Other	32,191 (40.3)	1,626 (42.5)	854 (67.0)

Abbreviations: ADPKD, autosomal dominant polycystic kidney disease; IQR, interquartile range; SD, standard deviation.

Table 2 Dialysis-related utilization and hospitalization rates of ADPKD patients and controls

	Control	ADPKD
Number of dialysis treatments per month
Months 0–2
Mean (SD)	9.1 (3.7)	10.7 (4.7)
Median (IQR)	9.0 (7.0–11.0)	10.0 (8.0–12.0)
Patient-months	7,546	2,526
Months 3–29
Mean (SD)	11.8 (5.5)	14.2 (6.6)
Median (IQR)	12.1 (10.0–12.9)	12.7 (11.6–13.1)
Patient-months	57,666	22,468
Months 30+
Mean (SD)	13.2 (5.5)	14.1 (5.9)
Median (IQR)	12.8 (11.8–13.1)	12.9 (11.9–13.3)
Patient-months	7,698	3,251
Overall
Mean (SD)	11.1 (5.1)	13.6 (6.3)
Median (IQR)	11.6 (8.7–12.6)	12.4 (10.8–13.0)
Patient-months	72,910	28,245
Hospitalization rates per 100 patient-months
Months 0–2
IR (95% CI)	17.4 (16.5–18.4)	9.9 (8.7–11.2)
Hospital admissions	1,312	249
Patient-months	7,546	2,526
Months 3–29
IR (95% CI)	15.4 (15.1–15.7)	8.4 (8.1–8.8)
Hospital admissions	8,865	1,896
Patient-months	57,666	22,468
Months 30+
IR (95% CI)	13.9 (13.1–14.8)	9.2 (8.2–10.3)
Hospital admissions	1,073	298
Patient-months	7,698	3,251
Overall
IR (95% CI)	15.4 (15.1–15.7)	8.6 (8.3–9.0)
Hospital admissions	11,250	2,443
Patient-months	72,910	28,245

Abbreviations: ADPKD, autosomal dominant polycystic kidney disease; CI, confidence interval; IQR, interquartile range; IR, incidence rate; SD, standard deviation.

Figure 1 Hospitalization rates per 100 patient-months, stratified by primary payer.

Note: Data presented as incidence rate with corresponding 95% confidence intervals.
Abbreviation: ADPKD, autosomal dominant polycystic kidney disease.

Table 3 Patient demographic data stratified by primary payer

	Control		ADPKD
	Medicare (n=2,196)	Other (n=1,626)	Medicare (n=420)	Other (n=854)
Age, years
Mean (SD)	70.8 (12.1)	52.0 (12.4)	66.1 (13.3)	50.6 (9.4)
Median (IQR)	72 (66–79)	54 (45–61)	69 (57–76)	51 (44–58)
Range	18–>90	18–89	23–89	19–28
Sex, n (%)
Female	993 (45.2)	652 (40.1)	215 (51.2)	397 (46.5)
Male	1,203 (54.8)	974 (59.9)	205 (48.8)	457 (53.5)
Race/ethnicity, n (%)
Caucasian	1,243 (56.6)	652 (40.1)	318 (75.7)	583 (68.3)
African-American	584 (26.6)	550 (33.8)	58 (13.8)	117 (13.7)
Hispanic	237 (10.8)	278 (17.1)	28 (6.7)	93 (10.9)
Other	131 (6.0)	145 (8.9)	16 (3.8)	61 (7.1)
Access/modality, n (%)
Catheter	62,696 (78.4)	1,284 (79.0)	204 (48.6)	462 (54.1)
Fistula	10,759 (13.5)	200 (12.3)	141 (33.6)	260 (30.4)
Graft	2,868 (3.6)	46 (2.8)	21 (5.0)	31 (3.6)
Peritoneal dialysis	3,336 (4.2)	88 (5.4)	54 (12.9)	101 (11.8)
Unknown	268 (0.3)	8 (0.5)	0 (0.0)	0 (0.0)
Post-dialysis weight, kg
Mean (SD)	79.5 (21.2)	84.2 (24.2)	75.4 (19.9)	84.0 (23.6)
Median (IQR)	76.6 (64.5–90.9)	79.6 (66.5–97.7)	71.0 (61.5–85.4)	80.3 (66.6–97.6)
Range	29.5–199.4	30.2–235.7	38.0–161.1	32.5–195.7
Body mass index, kg/m^2
Mean (SD)	28.2 (7.3)	29.0 (7.8)	26.4 (6.2)	28.0 (7.4)
Median (IQR)	26.9 (23.2–31.7)	27.6 (23.3–32.9)	25.0 (22.3–29.1)	26.4 (22.9–31.6)
Range	13.9–67.7	13.1–70.4	15.8–56.8	14.5–96.5
Diabetes, n (%)	825 (37.6)	613 (37.7)	50 (11.9)	82 (9.6)
Heart failure, n (%)	393 (17.9)	224 (13.8)	38 (9.0)	38 (4.4)
Coronary disease, n (%)	304 (13.8)	115 (7.1)	52 (12.4)	49 (5.7)
Cerebrovascular disease, n (%)	128 (5.8)	48 (3.0)	19 (4.5)	18 (2.1)
Charlson Comorbidity Index
Mean (SD)	5.9 (1.4)	4.1 (1.4)	4.5 (1.6)	3.0 (0.9)
Median (IQR)	6 (5–7)	4 (3–5)	5 (4–6)	3 (2–4)
Range	2–12	2–8	2–19	2–7

Abbreviations: ADPKD, autosomal dominant polycystic kidney disease; IQR, interquartile range; SD, standard deviation.

Table 4 Part A, Part B, and Part D costsa of Medicare ADPKD patients and controls

	Costs (PPPM)
	Part A		Part Bb		Part D prescription drug costsc
	Control	ADPKD	Control	ADPKD	Control	ADPKD
Months 0–2
Mean (95% CI)	6,426 (6,079; 6,773)	4,961 (4,424; 5,499)	1,193 (1,014; 1,371)	636 (397; 876)	348 (264; 432)	325 (205; 446)
Median (IQR)	4,547 (3,197–8,245)	3,737 (2,711–5,527)	711 (233–1,573)	496 (138–778)	244 (100–458)	296 (140–418)
Patient-months	4,214	798	523	84	305	34
Months 3–29
Mean (95% CI)	4,228 (3,983; 4,472)	3,088 (2,789; 3,387)	786 (715; 856)	429 (369; 488)	268 (241; 295)	222 (190; 254)
Median (IQR)	3,138 (1,590–5,469)	2,469 (1,650–3,945)	441 (212–864)	275 (134–535)	165 (82–319)	136 (68–321)
Patient-months	37,601	10,289	23,835	6,006	20,004	4,532
Months 30+
Mean (95% CI)	4,747 (4,132; 5,362)	4,595 (3,374; 5,816)	1,232 (1,071; 1,394)	987 (730; 1,244)	561 (481; 641)	564 (444; 683)
Median (IQR)	2,916 (1,985–5,701)	2,648 (2,001–5,370)	799 (495–1,306)	652 (405–980)	376 (191–704)	349 (184–805)
Patient-months	5,862	2,300	2,709	909	2,417	681
Overall
Mean (95% CI)	4,731 (4,485; 4,977)	3,517 (3,228; 3,807)	815 (758; 872)	472 (420; 524)	295 (270; 321)	265 (228; 301)
Median (IQR)	3,790 (2,351–6,144)	3,014 (2,187–4,573)	529 (301–1,002)	351 (210–581)	198 (103–372)	171 (97–346)
Patient-months	47,677	13,387	27,067	6,999	22,726	5,247

Notes:

a US dollar amounts;

b analysis included patients with at least one claim for Part B in each given time period;

c analysis included patients with at least one claim for Part D in each given time period.

Abbreviations: ADPKD, autosomal dominant polycystic kidney disease; CI, confidence interval; IQR, interquartile range; PPPM, per patient per month.