• Donna Spencer, Stephan Dunning, Jeff McPheeters, Jennifer St Clair Russell, and Christopher Hane.
• RTI International, 3040 E Cornwallis Rd, Research Triangle Park, NC 27709. Email: dspencer@rti.org.
• Am J Manag Care. 2023 Feb 1; 29 (2): e64e68e64-e68.

ObjectivesMany individuals with chronic kidney disease (CKD) are undiagnosed or unaware of the disease and at risk of not receiving services to manage their condition and of "crashing" into dialysis. Past studies report higher health care costs among patients with delayed nephrology care and suboptimal dialysis initiation, but they are limited because they focused on patients undergoing dialysis and did not evaluate costs associated with unrecognized disease for patients "upstream," or patients with late-stage CKD. We compared costs for patients with unrecognized progression to late-stage (stages G4 and G5) CKD and end-stage kidney disease (ESKD) with costs for individuals with prior CKD recognition.Study DesignRetrospective study of commercial, Medicare Advantage, and Medicare fee-for-service enrollees 40 years and older.MethodsUsing deidentified claims data, we identified 2 groups of patients with late-stage CKD or ESKD, one group with prior evidence of CKD diagnosis and the other without, and compared total and CKD-related costs in the first year following late-stage diagnosis between the 2 groups. We used generalized linear models to determine the association between prior recognition and costs and used recycled predictions to calculate predicted costs.ResultsTotal and CKD-related costs were 26% and 19% higher, respectively, for patients without prior diagnosis compared with those with prior recognition. Total costs were higher both for unrecognized patients with ESKD and unrecognized patients with late-stage disease.ConclusionsOur findings indicate that costs associated with undiagnosed CKD extend to patients not yet requiring dialysis and highlight potential savings from earlier disease detection and management.

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