만성 신장 질환 진행 단계 및 신대체요법에 따른 임상적 특성과 의료비 지출 비교

Abstract

The worsening of chronic kidney disease (CKD) leads to an increase in renal replacement therapies (RRT), which pose significant clinical and economic burdens. The purpose of this study was to estimate clinical characteristics and medical expenditure across CKD stage and RRT initiation. Using the 2018 National Patient Sample claims data, we identified 9,006 patients diagnosed with CKD (N18) were extracted. RRT options included hemodialysis, peritoneal dialysis, and kidney transplantation. Adopting a prevalence-based approach, we compared the clinical characteristics, healthcare resource utilization, and medical expenditures by CKD stage and the use of RRT. The prevalence of CKD increased with age, 41% in those aged 70 and above. Among patients with stage5 CKD, 78.75% underwent RRT. When comparing patients receiving RRT with those not receiving RRT, the annual average number of admissions (2.2 vs. 0.2), length of stay (56.6 vs. 23.1 days), and number of outpatient visits (101.0 vs. 5.2) were higher in the RRT group. Additionally, the average expenditure escalated with advancing CKD stages; the expenditure difference between stage3 and 4 was 2.8 times, and between stage4 and 5 was 15 times. Patients undergoing RRT spent 17.6 times more than those not receiving RRT (29,237,778 vs. 1,660,351 KRW). This study concludes that the aggravation of CKD can lead the financial toxicity due to RRT initiation, highlighting the need of appropriate management in early and moderate stages of CKD.