Humanistic burden and economic impact of chronic kidney disease: a systematic literature review

Abstract

Background: Chronic kidney disease (CKD) is increasing in prevalence worldwide. Progression of CKD to end-stage renal disease (ESRD) can result in the requirement for renal replacement therapy, which incurs considerable healthcare costs and imposes restrictions on patients’ daily living. This systematic review was conducted to inform understanding of the humanistic and economic burden of CKD by collecting quality of life (QoL), symptom burden, and cost and resource use data, with a focus on the impact of disease progression. Methods: Embase, MEDLINE, the Cochrane Library, and conference proceedings were searched in May 2017 according to predefined inclusion criteria. Data were extracted for full publications reporting either QoL or symptom burden (published 2007–2017; reporting data from ≥ 100 patients) or costs and resource use (published 2012–2017). Relevant QoL studies were those that used the 6-dimension or 8-, 12-, or 36-item Short-Form Health Surveys, 5-dimension EuroQol questionnaire, Healthy Days/Health-Related Quality of Life questionnaire, or Kidney Disease Quality of Life Questionnaire. Results: Data were extracted from 95 studies reporting QoL data, 47 studies reporting cost and resource use data, and eight studies reporting descriptions of symptoms; 12 studies (seven QoL; five costs/resource use) reported data for patients with and without CKD, and 15 studies (seven QoL; eight costs/resource use) reported data by disease stage. Patients with CKD, including those with ESRD, had worse QoL than those with normal kidney function, and incurred higher healthcare costs. Disease progression was associated with cost increases, particularly for later stages and in patients receiving dialysis. Increasing CKD severity was also associated with reductions in QoL, although not all studies identified showed a consistent decrease with increasing disease stage. Conclusions: The presence of CKD and CKD progression are associated with reductions in patients’ QoL and increased economic impact. This may be mitigated by interventions that slow progression.