Two of a KinD - Kidney Health Australia

Two of a KinD
(Kidneys in Diabetes)
The burden of diabetic kidney disease and the cost effectiveness
of screening people with type 2 diabetes for chronic kidney disease
Type 2 diabetes is now the leading cause of life threatening chronic kidney disease (CKD)
in Australia, with the two conditions forming an interrelated and sinister relationship called
‘diabetic kidney disease’.
Treatment strategies for these disease states need to recognise and reflect that the
conditions frequently co-exist and accelerate the progression of one another, often without
overt symptoms.
Dr Tim Mathew
National Medical Director
Kidney Health Australia
Kidney Health Australia engaged Deloitte Access Economics to estimate the economic cost
of CKD in people with type 2 diabetes, and to evaluate the viability of an Australia-wide
CKD screening program for people with type 2 diabetes.
This major study provides valuable insights into the prevalence of diabetic kidney
disease in Australia and the total economic burden of the condition, including direct costs
to the health care system, the financial impact beyond the health care system, and the loss
of healthy life.
The Report provides recommendations on ways to delay or prevent the progression of
kidney disease in patients with type 2 diabetes, as well as recommendations on maintaining
glycaemic control among diabetes patients threatened with the loss of kidney function.
Importantly, the analysis estimates that annual kidney function screening for people with
type 2 diabetes aged 50-69 would result in more than 14,500 years of healthy life gained,
more than 1,800 lives saved and more than 1,350 fewer people requiring Renal Replacement
Therapy as a result of early diagnosis and treatment to avoid end-stage kidney disease.
Further effort to screen and treat new patients with type 2 diabetes in this age bracket
would save 190 lives and mean more than 1,500 years of healthy life being gained.
Kidney Health Australia National Office
GPO Box 9993, Melbourne VIC 3001
Information Service: 1800 454 3639
Type 2 diabetes and kidney disease
- A sinister relationship
In 2010, there were more than 280,000 Australians living with diabetic kidney disease – a number that is likely to
escalate as the population ages and the prevalence of diabetes increases.
Estimated prevalence of CKD in people with type 2 diabetes, 2010, 2015, 2020
People with type 2 diabetes (thousands)
CKD Stage
2010
2015
2020
275.0
301.6
326.8
One
71.3
78.2
84.7
Two
93.9
103.0
111.6
Three
99.7
109.4
118.5
Four
10.1
11.1
12.0
Total ESKD patients
7.1
9.4
11.7
ESKD patients on RRT
5.9
7.8
9.8
ESKD patients treated conservatively
1.2
1.6
1.9
282.1
311.0
338.5
CKD stages one to four
Total CKD
Note: In people aged 25 years and over. Assumes prevalence rates remain constant.
Source: Deloitte Access Economics calculations using White et al (2010), and AusDiab data (1999-00) using Baker IDI Heart and
Diabetes Institute special data request.
In patients with type 2 diabetes, CKD can
accelerate the complications often associated
with
diabetes,
including
nerve
and
eye
damage and cardiovascular disease, while poor
glycaemic control can in turn accelerate the
progression of kidney disease.
Patients with diabetic kidney disease suffer cardiovascular
events at more than twice the rate of those with diabetes
alone. Relative to healthy individuals, patients with
diabetic kidney disease have a 79% increased risk
of congestive heart failure, a 41% increased risk of
atherosclerotic vascular disease, and a 56% increased
risk of death.
Incident event rates, by event type and comorbidity
60
50
40
per 100
patient
years
30
20
10
0
All patients
CHF
AMICVA/TIA PVD
ASVD RRT
Death
Non-diabetes/non-CKD
Diabetes non-CKD
Non-diabetes/CKD
Diabetes/CKD
Note: AMI =Acute Myocardial Infarction, ASVD = Atherosclerotic vascular disease, CHF = Chronic Heart Failure, CVA = Cerebrovascular accident,
PVD = Peripheral vascular disease, RRT = Renal replacement therapy, TIA = Transient ischemic attack. Source: Foley et al (2005).
Annual Kidney Function Screening
With the overwhelming majority of CKD patients in stages one to four, where the
condition is generally asymptomatic, a large proportion of these people remain
undiagnosed.
CKD often becomes apparent only in its later stages
when up to 90% of kidney function has been lost
and the complications associated with both the
loss of kidney function and poor glycaemic control
are more pronounced. At this point preventative
therapy is often redundant.
Poor diagnosis of kidney disease in the absence of
a national screening program for people with type
2 diabetes has high cost consequences in terms of the
impact on patients’ quality of life, health care resources
and the economy in general.
Alternately, annual screening of kidney function in
patients with type 2 diabetes would allow for treatment
to be initiated to reduce the progression of CKD, reduce
health care costs and improve patient outcomes.
While
anti-diabetic
medications
that
improve
glycaemic control form an essential role in treating
patients with type 2 diabetes, the Report also
highlights that not all anti-diabetic treatments are
appropriate for patients with or at risk of developing CKD.
This is due to the decreased clearance of certain drugs
through the kidneys and as a result, the prolonged
exposure to the drug or its metabolites which may lead to
adverse side effects.
The Cost Burden of Diabetic Kidney Disease
The annual cost of diabetic kidney disease to the Australian
health care system is estimated at $466.8 million. This
includes the cost of hospital services, out of hospital
medical services (including general practitioners,
specialists, imaging and pathology), pharmaceuticals,
and the services of other health professionals. A further
$208 million is consumed by indirect costs and
loss of productivity.
The health care cost associated with diabetic
kidney disease is forecast to increase to more
than $682 million by 2015-16, and to more
than $914 million by 2020-21, based on
the expected rise in the
number of people with
end-stage
kidney
disease (ESKD) and
the increase in the
cost of delivering
health care service.
Total Cost of CKD in people
with type 2 diabetes, 2009-10
Cost $ (million)
Health care costs
466.8
Indirect economic loss
208.0
Productivity loss
65.8
Informal carer costs
38.9
Transport costs
3.5
Deadweight loss
99.8
Total - Health care costs and
indirect economic loss
674.8
The annual cost of caring for each patient with advanced kidney disease is estimated to be $74,000 or three times the
cost of a heart attack survivor.
“
”
The greatest cost burden associated with kidney disease is incurred at the later stages
when Renal Replacement Therapy (kidney dialysis and transplantation) is required.
“
The management of diabetes over the long term must recognise
”
and reflect that the condition often coexists with and accelerates
the progression of kidney disease and other complications.
Cost Effectiveness of CKD screening
Although some patients with type 2 diabetes are routinely
screened by their general practitioner to assess their level of
kidney function, there is no systematic CKD screening program
in Australia. This has large cost consequences through low
rates of early diagnosis and the associated loss of quality of life
and increased health care expenditure that accompanies later
stages of the condition.
The cost of testing the kidney function of Australians aged 50-69
years with type 2 diabetes and subsequent ARB (angiotensin
receptor blocker) or ACE Inhibitor (angiotensin-converting
enzyme) therapy for those with confirmed CKD would be $73.8
million in year one and was estimated to result in 14,485 years
of healthy life gained, 1,811 lives saved and 1,358 fewer people
requiring Renal Replacement Therapy due to patients avoiding
end-stage kidney disease.
For a subsequent cost of $7.7 million per annum, to screen
and treat new patients with type 2 diabetes in this
age bracket, 190 lives could be saved and
1,516 years of healthy life gained.
Australians with type 2 diabetes
aged between 50-69 years
should have their kidney
function tested annually as a
preventative measure to assist
with delaying / reducing kidney
function decline and to address
the medical and economic
burden associated with the
progression of both chronic
kidney disease and type 2
diabetes.
A kidney health test is as simple
as a urine test followed by a
blood test for those with excess
protein in their urine sample.
The Two of a KinD Report was produced by Deloitte
Access Economics for Kidney Health Australia following
an unconditional education grant from Boehringer
Ingelheim.
The full Report can be viewed at: www.kidney.org.au