J Korean Diabetes Assoc.  2006 Sep;30(5):355-362. 10.4093/jkda.2006.30.5.355.

Current Status of Diabetic End-Stage Renal Disease Using Korean Health Insurance Database

• Kim DJ
• Kim J
• Kim H
• Min KW
• Park SW
• Park IB
• Park JH
• Baik SH
• Son HS
• Ahn CW
• Oh JY
• Lee S
• Lee J
• Chung CH
• Choi KM
• Choi I
• Kim H

• KMID: 2008265
• DOI: http://doi.org/10.4093/jkda.2006.30.5.355

Abstract

BACKGROUND: Diabetes is becoming one of the main causes of end-stage renal disease (ESRD) worldwide. We studied the prevalence and incidence of end-stage renal disease (ESRD) in the Korean population based on health insurance claims submitted to the Health Insurance Review Agency. We also investigated the proportion of medications taken by the ESRD patients, and frequency of hospital admission or visits, and medical expenses between ESRD patients with and without diabetes.
METHODS
This study was based on health insurance claims submitted to the Health Insurance Review Agency during the period from January 2001 through December 2003. Using the disease-classification codes on the health insurance claim forms, those who were diagnosed with chronic renal disease (N18 or N19) and received dialysis-related treatment (Z49), treatment with a kidney dialysis machine (Z99.2), or kidney transplantation (Z94.0) were defined as ESRD patients. Among the ESRD patients, those who were diagnosed with diabetes (E10-E14) and/or took anti-diabetic drugs were defined as ESRD patients with diabetes.
RESULTS
The ESRD patients totaled 33,870 in 2001, 37,894 in 2002, and 41,167 (858.3 per million population) in 2003. ESRD patients with diabetes increased to 56.7% in 2003. The number of ESRD patients in whom renal replacement therapy was initiated was 8,134 in 2002 and 8,322 (173.5 per million population) in 2003. ESRD patients with diabetes used more anti-hypertensive drugs (1.2 times as many), lipid-lowering drugs (1.6 times), and anti-platelet agents (1.8 times) than did ESRD patients without diabetes. In 2003, 66.5% of the ESRD patients with diabetes were hospitalized, which was 1.6 times the hospital admissions of ESRD patients without diabetes. ESRD patients with diabetes also had hospital stays that were 1.6 times longer per patient and inpatient service expenses that were 1.6times greater per patient, compared with those reported for ESRD patients without diabetes.
CONCLUSION
The incidence of ESRD accompanied by diabetes has risen rapidly. Given the burden of medical treatment costs placed on ESRD patients with diabetes, more aggressive interventions should be implemented to prevent diabetes and renal complications among patients with diabetes.

Keyword

Cost; Diabetes; End-stage renal disease; Incidence; Prevalence

MeSH Terms

Antihypertensive Agents
Dialysis
Health Care Costs
Humans
Incidence
Inpatients
Insurance, Health*
Kidney
Kidney Failure, Chronic*
Kidney Transplantation
Length of Stay
Prevalence
Renal Insufficiency, Chronic
Renal Replacement Therapy
Antihypertensive Agents

Reference

1. International Diabetes Federation. Diabetes Atlas. 2003. 2nd ed. Belgium: International Diabetes Federation;17–71.

2. Park Y, Lee H, Koh CS, Min H, Yoo K, Kim Y, Shin Y. Prevalence of diabetes and IGT in Yonchon County, South Korea. Diabetes Care. 1995. 18:545–548.

3. Kim SM, Lee JS, Lee J, Na JK, Han JH, Yoon DK, Baik SH, Choi DS, Choi KM. Prevalence of diabetes and impaired fasting glucose in Korea: Korean National Health and Nutrition Survey 2001. Diabetes Care. 2006. 29:226–231.

4. Lee KU, Park JY, Kim SW, Lee MH, Kim GS, Park SK, Park JS. Prevalence and associated features of albuminuria in Koreans with NIDDM. Diabetes Care. 1995. 18:793–799.

5. Kim SY, Jin DC, Bang BK. Current status of dialytic therapy in Korea. Nephrology. 2003. 8:S2–S9.

6. 2005 Annual data report: Atlas of End-Stage Renal Disease in the United States. National Institute of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Division of kidney, urologic & hematologic diseases. United States Renal Data System. 2005. Bethesda, MD: http://www.usrds.org.

7. http://www.ksn.or.kr.

9. http://www.konos.go.kr.

10. Gordois A, Scuffham P, Shearer A, Oglesby A. The health care costs of diabetic nephropathy in the United States and the United Kingdom. J Diabetes Complications. 2004. 18:18–26.

11. Brandle M, Zhou H, Smith BR, Marriott D, Burke R, Tabaei BP, Brown MB, Herman WH. The direct medical cost of type 2 diabetes. Diabetes Care. 2003. 26:2300–2304.

12. Smith DG, Harlan LC, Hawthorne VM. The charges for ESRD treatment of diabetics. J Clin Epidemiol. 1989. 42:111–118.

13. Joyce AT, Iacoviello JM, Nag S, Sajjan S, Jilinskaia E, Throop D, Pedan A, Ollendorf DA, Alexander CM. End-stage renal disease-associated managed care costs among patients with and without diabetes. Diabetes Care. 2004. 27:2829–2835.

14. The Diabetes Control and Complications (DCCT) Research Group. Effect of intensive therapy on the development and progression of diabetic nephropathy in the Diabetes Control and Complications Trial. Kidney Int. 1995. 47:1703–1720.

15. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998. 352:837–853.

16. UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2diabetes: UKPDS 38. BMJ. 1998. 317:703–713.

17. Lewis EJ, Hunsicker LG, Bain RP, Rohde RD. The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy. The Collaborative Study Group. N Engl J Med. 1993. 329:1456–1462.

18. Lewis EJ, Hunsicker LG, Clarke WR, Berl T, Pohl MA, Lewis JB, Ritz E, Atkins RC, Rohde R, Raz I. Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med. 2001. 345:851–860.

19. Brenner BM, Cooper ME, de Zeeuw D, Keane WF, Mitch WE, Parving HH, Remuzzi G, Snapinn SM, Zhang Z, Shahinfar S. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med. 2001. 345:861–869.