Chronic Kidney Disease
Conditions
Brief summary
This is a retrospective, multinational, non-interventional, observational study. A series of cohort studies will be conducted to assess the prevalence of undiagnosed stage 3 CKD in each region. The study will also assess the current state of CKD management in patients with undiagnosed CKD
Detailed description
This study is a retrospective, multinational, non-interventional observational study. The study does not attempt to test any specific a priori hypothesis; it is descriptive only and will collect data under conditions of routine medical care. Relevant secondary databases will be identified, and a series of cohort studies will be conducted to assess the prevalence of undiagnosed CKD. The study will also assess the current state of CKD management in patients with undiagnosed CKD. Primary Objectives 1. Estimate the point prevalence of undiagnosed stage 3 CKD (proportion of patients with eGFR measurements indicating stage 3 CKD with no corresponding CKD diagnostic code either before or up to six months after the second abnormal eGFR value) 2. Describe time to CKD diagnosis in patients with no prior CKD diagnosis code at index date (time of second qualifying eGFR), overall and by patient characteristics Secondary Objectives 1. Assess trends in the prevalence (point prevalence) of undiagnosed CKD by calendar year 2. Describe baseline characteristics among those with undiagnosed versus diagnosed CKD 3. Assess CKD management and monitoring practices (post index date) in patients with diagnosed versus undiagnosed CKD Exploratory objectives (pending feasibility) 1. Describe the risk of selected adverse clinical outcomes longitudinally among those with undiagnosed versus diagnosed CKD 2. Describe HCRU associated with undiagnosed versus diagnosed CKD 3. Assess association between the timing of the CKD diagnosis and the risk of selected adverse clinical outcomes and HCRU in patients with no CKD diagnosis code prior to the index date 4. Describe health care costs associated with undiagnosed versus diagnosed CKD 5. For CKD patients with eGFR 25-75 mL/min/1.73m2 and urine albumin creatinine ratio (UACR) 200 - 5000 mg/g (DAPA-CKD trial-like population): 1. Estimate the point prevalence of undiagnosed CKD 2. Describe the risk of selected adverse clinical outcomes longitudinally among those with undiagnosed CKD 3. Describe HCRU and costs associated with undiagnosed CKD
Interventions
None listed
Sponsors
AstraZeneca
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* At least two consecutive eGFR laboratory tests with values ≥30 and \<60 mL/min/1.73 m2 (Stage 3A or 3B) that are \>90 and ≤730 days apart. The index date is the date of the second eGFR measure meeting the criteria for stage 3 CKD * At least 12 months of continuous presence in the database or registration in the data prior to the first qualifying eGFR (for data sources with information on enrolment) * Age ≥18 years at index date
Exclusion criteria
* Solid organ transplant before the study index date * Any evidence of advanced CKD (stage 4, 5) based on CKD diagnostic codes, or renal replacement therapy before the index date
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Prevalence of undiagnosed stage 3 chronic kidney disease (CKD) | From 2015 assessed throughout the study, up to a maximum of 8 years | Undiagnosed stage 3A-3B CKD identified as having no healthcare encounter with a diagnosis code for CKD any time before or up to six months post index date (date of second consecutive estimated glomerular filtration rate \[eGFR\] value indicating stage 3 CKD recorded at least 90 days after the first abnormal eGFR value), assessed overall and by calendar year |
| Time to CKD diagnosis | From second abnormal eGFR value until the date of CKD diagnosis or end of follow-up, assessed throughout the study period, up to a maximum of 5 years | Time to CKD diagnosis in patients no CKD diagnosis code any time prior to laboratory measurements indicating stage 3 CKD |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of patients tested for CKD | From six months after the second abnormal eGFR measurement, assessed throughout the study period until end of follow-up, up to a maximum 6 months | \- UACR test |
| Proportion of patients monitored for kidney function and complications | From six months after the second abnormal eGFR measurement, assessed throughout the study period until end of follow-up, up to a maximum 18 months | * Serum Cr test (outpatient) * Patients receiving a UACR test (outpatient) * Serum calcium * Phosphate * Albumin * Bicarbonate * Potassium * Hemoglobin * Albuminuria |
| Proportion of patients prescribed selected medications | From six months after the second abnormal eGFR measurement, assessed throughout the study period until the end of follow-up, up to a maximum 5 years | * Statin prescription * Angiotensin converting enzyme inhibitors (ACEis) or angiotensin receptor blockers (ARBs) * Sodium-glucose cotransporter-2 (SGLT2) inhibitors * Vaccination (influenza) |
| Proportion of patients monitored for high blood pressure | From six months after the second abnormal eGFR measurement, assessed throughout the study period until end of follow-up, up to a maximum 5 years | * Patients receiving BP measurement * BP measurement ≤140/90 * BP measurement ≤ 130/80 in patients with evidence of albuminuria and/or diabetes |
| Proportion of patients monitored for glycaemic control | From six months after the second abnormal eGFR measurement, assessed throughout the study period until end of follow-up, up to a maximum 5 years | \- HbA1c test in patients with diabetes |
| Proportion of patients receiving kidney function monitoring after initiation of angiotensin receptor blocker or angiotensin converting enzyme inhibitors | From six months after the second abnormal eGFR measurement, assessed throughout the study period until end of follow-up, up to a maximum 5 years | \- An outpatient serum creatinine measurement |
| Describe proportion of patients comorbidities and other patient characteristics | From 2015 assessed throughout the study, up to a maximum of 8 years | Describe patient characteristics including demographics, clinical assessments, family history, procedures, laboratory measurements, treatment patterns and clinical history (comorbidities) stratified by CKD diagnosis status |
Other
| Measure | Time frame | Description |
|---|---|---|
| Incidence of Cardiovascular (CV) events | From six months after the second abnormal eGFR until the date of a CV event, assessed throughout the study until end of follow-up, up to a maximum of 5 years | * Composite of non-fatal MI, non-fatal stroke, or CV death * Composite of non-fatal MI, non-fatal stroke, or all-cause mortality) * Composite of non-fatal MI, non-fatal stroke, hospitalization for unstable angina, hospitalization for heart failure, or CV death * Stroke * Hospitalisation for heart failure |
| Describe health care resource utilisation and associated costs | From six months after the second abnormal eGFR, assessed throughout the study until end of follow-up, up to a maximum of 5 years | To understand the healthcare resource use and cost associated with undiagnosed CKD |
| CKD progression | From six months after the second abnormal eGFR until the date of CKD progression, assessed throughout the study until end of follow-up, up to a maximum of 5 years | Progression to CKD stage 4 or higher |
| Incidence of all-cause mortality | From six months after the second abnormal eGFR until death due to any cause, assessed throughout the study until end of follow-up, up to a maximum of 5 years | All-cause mortality |
| Incidence of adverse renal events | From six months after the second abnormal eGFR until the date of an adverse renal outcome, assessed throughout the study until end of follow-up, up to a maximum of 5 years | * Sustained ≥50% reduction in eGFR; or * End stage kidney disease (ESKD); defined as a composite of chronic dialysis, renal transplant, or sustained eGFR\<15mL/min/1.732 (at least two consecutive measures ≥28 days apart) |
Countries
Australia, Brazil, Canada, China, France, Germany, Italy, Japan, Spain, United Kingdom, United States
Outcome results
None listed