Prognostic value of claims data for chronic kidney disease associated health risks

BACKGROUND: Chronic kidney disease (CKD) associates with kidney failure and overall health risks. We here investigated the prognostic value of claims data in the absence of biochemical data. METHODS: 29,144 persons insured at AOK Rhineland-Hamburg with a diagnosis of CKDIII or CKDIV in 2016 were included into analyses of renal replacement therapy (rRT), death, hospital admissions and diagnoses, and prescription of CKD-related therapies during the ensuing six-year period (2017-2022) using corresponding billing codes. RESULTS: In 22,228 individuals diagnosed with CKDIII and 6,916 with CKDIV during the base year, rRT was prescribed in 3.8% and 14.3% during the observation period, 7.0% and 13.3% were admitted to the hospital for acute kidney injury (AKI). A combination of claims data significantly contributed to prognosis of rRT (AUC 0.87) and AKI (AUC 0.68) and overall outcomes death (AUC 0.97), hospital admission for heart failure (AUC 0.76) and intensive care unit (ICU) therapy (AUC 0.67). All AUC significantly improved after inclusion of CKD stage into the model. Outpatient prescriptions of Renin-Angiotensin-system and sodium-glucose cotransporter 2 (SGLT2) inhibitors associated with significantly better renal and cardiovascular outcomes. Prescription of CKD-related pharmacotherapy for calcium metabolism (AUC 0.74), hyperkalemia/hyperphosphatemia (AUC 0.83), metabolic acidosis (AUC 0.81), erythropoiesis stimulating agents (AUC 0.65), and hyperuricemia therapy (AUC 0.72) was prognosticated by claims data with significant contribution of CKD stage. SUMMARY AND CONCLUSION: Claims data provide prognostic information for renal and overall outcomes in CKDIII and CKDIV patients even in the absence of laboratory measurements. Inclusion of additional values should be evaluated in patients with and without CKD for individualized risk calibration.