#4529 PACE-CKD: FINANCIAL BURDEN AND WORK PRODUCTIVITY OF PATIENTS WITH CKD AND CAREGIVERS: RESULTS FROM A US SURVEY
Authors: Chadban Steven , Esposito Ciro , Rangaswami Janani , Wu Mai-Szu , Hull Richard , Elsayed Hesham , Reichel Helmut , Sanchez Juan Jose Garcia , Pentakota Surendra , Kularatne Thames , Fifer Simon 
Published: June 2023

Abstract

Background and Aims
Chronic kidney disease (CKD) is a progressive condition, conferring serious mortality and morbidity in patients with advanced disease. Upon reaching end-stage kidney disease (ESKD), dialysis or kidney transplantation is typically required, leading to considerable burden to health care systems worldwide. There is a paucity of data assessing the financial wellbeing and work productivity of patients with CKD and their caregivers, compared to the general population. Therefore, the objective of this study was to conduct a quantitative online survey to estimate the financial burden and work productivity of patients with CKD and their caregivers relative to the general population.

Method
This non-interventional survey included adult patients with a diagnosis of CKD for at least 3 months and unpaid caregivers of CKD patients for a minimum of 1 hour per week in the previous 4 weeks. ESKD was defined by patients with CKD stage 5 or patients undergoing kidney transplantation or dialysis. Patients and caregivers were matched by key demographic characteristics (e.g. age, gender and area of residence) to respective general population cohorts. Patients and caregivers were assessed using the Consumer Financial Protection Bureau (CFPB) general financial well-being scale (scores from 0 to 100) and financial burden was assessed using the FACIT-COST score (5 point Likert type scale). Work productivity was assessed using the Work Productivity and Activity Impairment (WPAI) questionnaire (WPAI:GH for patients, adjusted WPAI-CG ADAPTED for caregivers).

Results
The study enrolled 199 patients (median age: 58 years) with CKD and 113 caregivers (median age: 38 years) in the United States. Candidates were enrolled between June and July 2022. In the patient cohort, 32.2% of participants were dialysis-dependent, who predominately received treatment in a clinic or hospital (79.7%) rather than at home. Caregivers most commonly cared for their parent (45.1%) or partner (25.7%); the most frequent role for caregivers was providing transport to/from medical appointments (89.4%). Patients were considered to have 17.8% worse financial wellbeing compared to the general population according to the CFPB scale (52.0 vs 63.2, respectively). Caregivers reported slightly lower financial wellbeing than the general population (55.8 vs 56.4, respectively). Patients receiving dialysis experienced a similar financial burden to non-dialysis dependent patients, with slightly worse FACIT-COST scores (22.9 vs 23.4, respectively). Further, patients and caregivers reported losses to work productivity with dialysis patients (21.6%) reporting higher absenteeism from work than non-dialysis patients (9.6%) when compared to the general population (3.6%). Similarly, carers of dialysis-dependent patients reported a higher rate of absenteeism (14.8%) compared to carers of non-dialysis dependent patients (10.6%) and the general population (5.2%). Total activity impairment was higher for dialysis dependent patients (55.5%) than for non-dialysis dependent patients (43.7%) and considerably higher versus the general population (5.7%). Caregivers for dialysis dependent patients had greater total activity impairment (44.3%) than caregivers for non-dialysis dependent patients (34.3%) and the general population (17.3%). Results for patients and caregivers in other countries (United Kingdom, Germany, and Mexico) will also be presented at the congress.

Conclusion
The results of this survey suggest that work productivity is impaired in both CKD patients and their caregivers and is also exacerbated further in patients who progress to dialysis and their caregivers. The survey also provides indications that the financial wellbeing in patients with CKD may be affected in comparison to the general population. Evidence based policy interventions ought to consider the progressive nature of CKD and should aim to reduce the societal burden of disease for patients and carers.

Funding
This study was supported by AstraZeneca.