Background: Chronic kidney disease (CKD) is a prevalent condition; however, little is known about healthcare resource utilization (HRU) by CKD patients. Methods: This analysis included NHANES participants aged ≥18 years, with serum creatinine, urine protein, and hemoglobin measurements. We assessed the association between CKD (stratified by stage) and HRU based on self-reported physician visits and hospitalizations in the year preceding the survey. Results: Of the 15,258 included in this analysis, 2,110 had early CKD (stage 1 and 2 CKD) and 1,121 had late CKD (stage 3 and 4 CKD). Mean (SE) number of annual physician visits were 3.51 (0.08), 4.43 (0.18), and 6.53 (0.38) for participants with no CKD, early CKD, and late CKD, respectively. Mean (SE) number of annual hospitalizations were 0.15 (0.01), 0.19 (0.01), and 0.42 (0.03) for participants with no CKD, early CKD, and late CKD, respectively. Participants with late CKD were more likely to have more physician visits (OR 1.81, 95% CI 1.46, 2.23) and have more hospital admissions (OR 2.12, 95% CI 1.66, 2.71) compared with participants with early CKD or no CKD. Conclusions: In this analysis, late stage CKD was associated with increased HRU, suggesting the need for early identification and treatment of CKD and its associated conditions.

Coresh J, Selvin E, Stevens LA, Manzi J, Kusek JW, Eggers P, Van Lente F, Levey AS: Prevalence of chronic kidney disease in the united states. JAMA 2007;298:2038–2047.
Coresh J, Byrd-Holt D, Astor BC, Briggs JP, Eggers PW, Lacher DA, Hostetter TH: Chronic kidney disease awareness, prevalence, and trends among US adults, 1999–2000. J Am Soc Nephrol 2005;16:180–188.
US Renal Data System, USRDS 2007 Annual Data Report: Atlas of enD-STAGE RENAL DISEASE in the United States. Bethesda, NIH, National Institute of Diabetes and Digestive and Kidney Diseases, 2007.
Khan SS, Kazmi WH, Abichandani R, Tighiouart H, Pereira BJ, Kausz AT: Health care utilization among patients with chronic kidney disease. Kidney Int 2002;62:229–236.
Smith DH, Gullion CM, Nichols G, Keith DS, Brown JB: Cost of medical care for chronic kidney disease and comorbidity among enrollees in a large HMO population. J Am Soc Nephrol 2004;15:1300–1306.
Centers for Disease Control and Prevention (CDC): Hospitalization discharge diagnoses for kidney disease – United States, 1980–2005. MMWR 2008;57:309–312.
Plan and Operation of the Third National Health and Nutrition Examination Survey, 1988–1994. Vital Health Statistics 1 1994;32:1–407.
Ezzati TM, Massey JT, Waksberg J, Chu A, Maurer KR: Sample design: Third National Health and Nutrition Examination Survey. Vital Health Statistics 2 1992;113:1–35.
Coresh J, Astor BC, Greene T, Eknoyan G, Levey AS: Prevalence of chronic kidney disease and decreased kidney function in the adult us population: Third National Health and Nutrition Examination Survey. Am J Kidney Dis 2003;41:1–12.
Levey AS, Coresh J, Balk E, Kausz AT, Levin A, Steffes MW, Hogg RJ, Perrone RD, Lau J, Eknoyan G: National kidney foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med 2003;139:137–147.
Levey AS, Greene T, Kusek JW, Beck GJ: A simplified equation to predict glomerular filtration rate from serum creatinine (abstract). J Am Soc Nephrol 2000;11:A0828.
Manjunath G, Sarnak MJ, Levey AS: Prediction equations to estimate glomerular filtration rate: An update. Curr Opin Nephrol Hypertens 2001;10:785–792.
Coresh J, Astor BC, McQuillan G, Kusek J, Greene T, Van Lente F, Levey AS: Calibration and random variation of the serum creatinine assay as critical elements of using equations to estimate glomerular filtration rate. Am J Kidney Dis 2002;39:920–929.
National Kidney Foundation: K/DOQI Clinical Practice Guideline and Clinical Practice Recommendations for anemia in chronic kidney disease: 2007 update of hemoglobin target. Am J Kidney Dis 2007;50:471–530.
World Health Organization. Obesity: Preventing and Managing the Global Epidemic. Report of a WHO Consultation. Tech Rep Ser No 894. Geneva, WHO, 2000.
NHANES III Analytic and Reporting Guidelines. Hyattsville/Md, National Center for Health Statistics, Centers for Disease Control and Prevention. 1996 (accessed at, 2007).
Go AS, Yang J, Ackerson LM, Lepper K, Robbins S, Massie BM, Shlipak MG: Hemoglobin level, chronic kidney disease, and the risks of death and hospitalization in adults with chronic heart failure: the Anemia in Chronic Heart Failure: Outcomes and Resource Utilization (ANCHOR) Study. Circulation 2006;113:2713–2723.
Mix TC, St Peter WL, Ebben J, Xue J, Pereira BJ, Kausz AT, Collins AJ: Hospitalization during advancing chronic kidney disease. Am J Kidney Dis 2003;42:972–981.
Jurkovitz CT, Abramson JL, Vaccarino LV, Weintraub WS, McClellan WM: Association of high serum creatinine and anemia increases the risk of coronary events: results from the prospective community-based Atherosclerosis Risk in Communities (ARIC) Study. J Am Soc Nephrol 2003;14:2919–2925.
Langston RD, Presley R, Flanders WD, McClellan WM: Renal insufficiency and anemia are independent risk factors for death among patients with acute myocardial infarction. Kidney Int 2003;64:1398–1405.
Vlagopoulos PT, Tighiouart H, Weiner DE, Griffith J, Pettitt D, Salem DN, Levey AS, Sarnak MJ: Anemia as a risk factor for cardiovascular disease and all-cause mortality in diabetes: the impact of chronic kidney disease. J Am Soc Nephrol 2005;16:3403–3410.
Chan MR, Dall AT, Fletcher KE, Lu N, Trivedi H: Outcomes in patients with chronic kidney disease referred late to nephrologists: a meta-analysis. Am J Med 2007;120:1063–1070.
Orlando LA, Owen WF, Matchar DB: Relationship between nephrologist care and progression of chronic kidney disease. N C Med J 2007;68:9–16.
Khan S, Amedia CA Jr: Economic burden of chronic kidney disease. J Eval Clin Pract 2008;14:422–434.
McLaughlin K, Manns B, Culleton B, Donaldson C, Taub K: An economic evaluation of early versus late referral of patients with progressive renal insufficiency. Am J Kidney Dis 2001;38:1122–1128.
Petrou S, Murray L, Cooper P, Davidson LL: The accuracy of self-reported healthcare resource utilization in health economic studies. Int J Technol Assess Health Care 2002;18:705–710.
Ritter PL, Stewart AL, Kaymaz H, Sobel DS, Block DA, Lorig KR: Self-reports of healthcare utilization compared to provider records. J Clin Epidemiol 2001;54:136–141.
Roberts RO, Bergstralh EJ, Schmidt L, Jacobsen SJ: Comparison of self-reported and medical record health care utilization measures. J Clin Epidemiol 1996;49:989–995.
K/DOQI: Clinical practice guidelines on hypertension and antihypertensive agents in chronic kidney disease. Am J Kidney Dis 2004;43:S1–S290.
Bakker AJ: Detection of microalbuminuria. Receiver operating characteristic curve analysis favors albumin-to-creatinine ratio over albumin concentration. Diabetes Care 1999;22:307–313.
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