• Austin Campbell, Lihao Chu, Stanley Crittenden, Abe Sutton, and Adam Boehler.
• Evergreen Nephrology, 210 Athens Way, Ste 200, Nashville, TN 37228. Email: acampbell@evergreennephrology.com.
• Am J Manag Care. 2024 Jun 1; 30 (6): e172e177e172-e177.

ObjectivesChronic kidney disease (CKD) is a widely prevalent disease with heterogeneous disease progression. Prior study findings suggest that early referral to nephrologists can improve health outcomes for patients with CKD. Current practice guidelines recommend nephrology referral when patients are diagnosed with CKD stage 4. We tested whether a subset of patients with CKD stage 3 and common medical comorbidities demonstrates disease progression, cost, and utilization patterns that would merit earlier referral.Study DesignRetrospective study of Medicare fee-for-service beneficiaries with CKD stages 3 through 5 and end-stage kidney disease.MethodsWe identified 7 comorbidities with high prevalence in patients with progressive CKD and segmented beneficiaries with CKD stage 3 based on the presence of these comorbidities. Outcomes including costs, utilization, and disease progression were then compared across beneficiaries with different stages of CKD.ResultsWe identified that beneficiaries with CKD stage 3 and at least 1 of the selected comorbidities (CKD stage 3-plus) represented 35.4% of all beneficiaries with CKD stage 3. The CKD stage 3-plus cohort had cost and utilization patterns that were more similar to beneficiaries with CKD stages 4 and 5 than to beneficiaries with CKD stage 3 without the selected comorbidities.ConclusionsOur findings demonstrate the use of a claims-based algorithm to identify patients with CKD stage 3 who have high costs and are at risk of disease progression, highlighting a potential subset of patients who might benefit from earlier nephrology intervention.

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