PUK21 INCIDENCE OF SEVERE CHRONIC KIDNEY DISEASE AND COMORBIDITY AND CLINICAL PROFILES BY BODY MASS INDEX: A REAL-WORLD ANALYSIS USING CLAIMS AND ELECTRONIC HEALTH RECORDS

Abstract

Describe incidence of severe chronic kidney disease (CKD) and comorbidity profiles by patient body mass index (BMI) using real-world claims and electronic health records (EHR) database. Adults age ≥18 newly diagnosed with severe CKD (stage 4, 5, and end stage) between 6/30/2007 and 6/3/2017 were identified in the IBM® MarketScan® Explorys® Claims-EHR Data Set, which includes detailed medical and pharmacy claims data and clinical information in patient health records. Incidence of severe CKD were stratified by BMI measured during 1-year prior to CKD diagnosis (index event). The following BMI categories were used (kg/m2): Underweight <18.5, normal weight 18.5 to 24.9, overweight 25 to 29.9, obese 30 to 39.9, morbidly obese ≥ 40. Comorbid conditions and hemoglobin A1C (HbA1c) level during the 1-year pre-index were stratified by BMI. Patients with evidence of pregnancy or primary cancers were excluded. 7,724 patients were newly diagnosed with severe CKD, with 2% underweight, 22% normal weight, 30% overweight, 36% obese, and 10% morbidly obese (Mean age 71; 52% male). Prevalent of comorbid conditions increasing from underweight to morbidly obese categories were type 2 diabetes (T2DM) from 28% to 77%, dyslipidemia 45% to 68%, hypertension 80% to 92%, and congestive heart failure 38% to 47%. Depression (18-19%), COPD (36-37%), and pain (77-78%) were similar between underweight and morbidly obese categories but higher than normal (16%, 29%, 71%), overweight (13%, 27%, 70%) and obese (14%, 29%, 72%). Among a subset with HbA1c results, the mean HbA1c increased from 6.7 in normal weight to 7.2 in morbidly obese categories. While incidence of severe CKD diagnosis were higher in obese patients, patient BMI categories revealed different comorbidity profiles. Prevalence of T2DB and other metabolic syndrome conditions increased with BMI, while other conditions were highest among patients at the opposite ends of BMI spectrum.