(Gleaned from the 2018 USRDS Annual Data Report: Volume 1, Chapter 7: www.usrds.org)

Persons with chronic kidney disease (CKD), but not end-stage renal disease (ESRD) often have extensive healthcare needs and frequently face coexisting illnesses. Medicare beneficiaries enrolled in managed care grew from 13 percent in 2004 to 33 percent in 2017. In March 2017, 19 million individuals were enrolled in a Medicare Advantage plan.

It is not possible to attribute healthcare expenditures solely to kidney disease with any accuracy because the costs of CKD are influenced by its interactive nature and associations with other chronic conditions such as diabetes mellitus (DM) and hypertension (HTN), and with cardiovascular diseases (CVD) such as coronary artery disease, cerebrovascular disease, peripheral arterial disease and HF.

• Overall, people with diagnoses of any condition of CKD, DM, and/or HF accounted for one-third of the Medicare-aged 65 and older population, but over half of total programmatic costs.
• In those age 65 and older, per-person per-year (PPPY) costs at $16,176 were 93% higher for patients with CKD only, versus those with no CKD, DM, or HF ($8,400). For beneficiaries with CKD, HF and DM, costs were 49% higher than for those with only HF and DM.
• Medicare spending for all beneficiaries who had CKD (12.5% of total) exceeded $79 billion in 2016, an increase of 23% from 2015. Medicare spending for beneficiaries with CKD age 65 and older exceeded $67 billion, representing 25% of all Medicare spending in this age group.
• Medicare expenditures for CKD were 20% higher in 2016 than in 2015 ($55 billion), primarily driven by an 18% increase in the number of identified cases, particularly those in the earlier stages of CKD 1-3.
• Medicare spending for beneficiaries with CKD who were younger than age 65 (8% of total) exceeded $12 billion in 2016, representing 18% of total spending in this age group.
• Over half of the 2016 Medicare spending for beneficiaries who were 65 and older was for those who had diagnoses of CKD, diabetes mellitus (DM), or heart failure (HF).
• Over 78% of total Medicare spending for beneficiaries with CKD who were 65 and older was incurred by the 71% of these patients who also had DM, HF, or both.
• Spending per patient-year for those with all three chronic conditions of CKD, DM, and HF was more than twice as high ($39,506) than for beneficiaries with only CKD ($16,176).