Examining the Impact of CKD on Individuals, Caregivers

A pair of posters presented at Kidney Week 2022 examined some of the burdens of people living with chronic kidney disease (CKD), as well as their caregivers.

The first study sought to review estimates of economic and humanistic impact among individuals with CKD in the United States.¹

Using MEDLINE and Embase, researchers conducted a systematic review to identify studies reporting estimates of CKD economic or humanistic patient burden in the United States, published between 2016 and 2021. Study selection and data extraction were performed in duplicate, using PRISMA guidelines. A grey literature search was conducted for the past 5 years. Characteristics of patients with CKD, and estimates of economic and humanistic burden, were summarized.

From 4880 abstracts, 38 eligible studies were included.

Mean patient age ranged from 46.3 to 63.7 years; proportion of males ranged from 41.70% to 63.0%. Reported comorbidities included diabetes (23%.0-55.8%), cardiovascular disease (20.5%-63.0%), and hypertension (45.5%-97.0%).

Two studies reported out-of-pocket expenditures for patients with CKD, estimated at $1599 (mean) and $1807 (median) annually. More than 16% of patients had high OOP burden.

One study reported that 46.9% of patients with CKD of working age experienced financial hardship within the past year due to medical bills, with lack of health insurance being the strongest determinant; impacts included nonadherence to medication and delayed/foregone medical care.

Health-related quality of life (HRQOL) was assessed in 32 studies using a variety of instruments; high burden for patients with CKD was consistently demonstrated, with higher CKD stage linked with greater burden. Limited data were available on lost productivity.

The authors said the findings show the high economic and humanistic burden to individuals with CKD, although HRQOL data were heterogenous and economic data were limited.

The same authors conducted a second study, this time looking at the impact on unpaid caregivers.² Using the same search strategy, they retrieved 2990 abstracts and analyzed 8 studies reporting caregiver burden estimates.

As has been reported in numerous other studies about unpaid caregiving, they were mostly female (57.9%-78.4%) and were caring for their spouse/partner (42.1%-45.3%). Most were in their early 60s.

Time spent caregiving ranged from 27-38 hours/week, according to 2 studies. Caregiving duration ranged from 3.7 to 5.0 years.

In one study, 69.1% of caregivers for those with CKD and anemia made at least 1 job-related decision due to caregiving, including retiring early, reducing work hours, or quitting their job.

Two studies reported depression was identified by 31.6% to 36.4% of caregivers, while 2 studies noted anxiety was present in 31.6% to 43.6%.

The researchers said the estimates of the impact on those caring for patients with CKD were sparse and heterogenous, but they pointed out the large amount of time spent caregiving and frequent identification of depression and anxiety among caregivers.

In both studies, the authors said more research is needed to fully understand these issues.

Both studies were funded by Boehringer Ingelheim Pharmaceuticals.

References

1. Osenenko KM, Chatterjee S, Ray S, Li T, Donato BM. Economic and humanistic burden among individuals with CKD in the United States: a systematic literature review. Presented at: Kidney Week 2022; November 3-6, 2022; Orlando, Florida. Abstract TH-PO726.

2. Osenenko KM, Chatterjee S, Ray S, Li T, Donato BM. Impact of caring for individuals with CKD in the United States: a systematic literature review. Presented at: Kidney Week 2022; November 3-6, 2022; Orlando, Florida. Abstract TH-PO893.