IMPACT CKD: Holistic Disease Model Projecting 10-Year Population Burdens

Abstract

IntroductionThe significant burden of chronic kidney disease (CKD) is not recognized as a global public health priority, although policies aimed at delaying progression to later stages are required. Hence, there is need for a holistic disease model to inform decision-making that accounts for the multi-dimensional impact of CKD, and the interrelated factors that modulate progression. MethodsIMPACT CKD is a microsimulation model that simulates CKD progression and incorporates the effect of clinical events and comorbidities. CKD status is assigned using estimated glomerular filtration rate (eGFR) and albuminuria levels, and CKD progression is predicted by an annual eGFR decline rate. The model projects clinical, healthcare resource use, economic, patient, societal, and environmental burdens from 2022-2032. During development, face, technical, and external validity were evaluated, with calibration conducted to population data. Further, cross-validation was conducted against two published models. The United Kingdom (UK) was selected as the case study for validation. ResultsA 7.7% increase in the CKD population by 2032 was predicted, with increasing numbers of patients with CKD stage 3-5 (21.7%), dialysis (75.3%), and transplantation (58.7%). The rise of renal replacement therapy patients results in an increase of 75% across freshwater use, fossil fuel depletion, and CO2 emissions over the next decade, and an estimated cost of £1.95 billion in 2032. Projections reflect validated findings from other models. ConclusionThe IMPACT CKD model is a robust simulation that delivers validated forecasts of the holistic CKD burden, which can support evaluation of diverse health policies and treatment strategies.