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All-Cause Costs Increase Exponentially with Increased Chronic Kidney Disease Stage
Ladan Golestaneh, MD, MS; Paula J. Alvarez, RPh, MPH, MBA; Nancy L. Reaven, MA; Susan E. Funk, MBA, FACHE; Karen J. McGaughey, PhD; Alain Romero, PhD; Melanie S. Brenner, PharmD, BCPS; and Macaulay Onuigbo, MD, MSc, MBA

All-Cause Costs Increase Exponentially with Increased Chronic Kidney Disease Stage

Ladan Golestaneh, MD, MS; Paula J. Alvarez, RPh, MPH, MBA; Nancy L. Reaven, MA; Susan E. Funk, MBA, FACHE; Karen J. McGaughey, PhD; Alain Romero, PhD; Melanie S. Brenner, PharmD, BCPS; and Macaulay Onuigbo, MD, MSc, MBA
Statistical Analyses
Analysis of variance was performed in a mixed model with repeated measures to evaluate the statistical significance of observed differences in mean annualized total costs between each CKD stage and the preceding stage by payer group. Multivariate regression assessed predictors of cost within each CKD stage and payer group, with minor exclusions (unknown/other region; RAASi above maximum recommended dose; missing age/sex; kidney transplant patients in ESRD). The dependent variable of total annualized cost + $1 during each CKD stage and for the postindex period in the no-CKD cohort was log-transformed due to skew. Independent variables, evaluated with a stepwise selection procedure (alpha = .05), included age (continuous), sex, region, all defined comorbidities (heart failure [HF], DM, hypertension, cardiovascular disease [CVD], and hyperkalemia), RAASi therapy (maximum or submaximum dose vs discontinued), visit frequency (frequent/infrequent), and diuretics (loop/other/none). Interaction terms (selected a priori for clinical significance) included HF with hyperkalemia and RAASi therapy with specified comorbidities (DM, CVD, hypertension, and hyperkalemia).

A post hoc analysis of the multiple regression findings compared predicted annual cost of patients with and without hyperkalemia by modeling costs associated with variables not involving hyperkalemia at their mean values in each payer group and CKD stage, and variables involving hyperkalemia at their mean value among comparator group patients who had hyperkalemia.
P values <.05 were considered significant. All statistical analyses were performed using SAS/STAT software, version 9.2 (SAS Institute, Cary, NC).



 
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