HealthLumen, in conjunction with AstraZeneca, have recently published a body of research from the “INSIDE CKD” programme, part of a major strategic initiative at AstraZeneca which is dedicated to changing the future for CKD patients.

Our role is to support evidence-based policy making in CKD, which we do by harnessing the predictive power of microsimulation, a computer modelling approach that models future trends, based on country-specific healthcare data, to a highly granular level of detail, modelling disease emergence, progression and outcomes, at a patient-level.

CKD is a debilitating, long-term condition that becomes more burdensome and harder to treat as it progresses, culminating in the need for dialysis and kidney transplant, at end stage kidney disease.

In addition to the increasing prevalence and limited treatment options, CKD is a ‘disease multiplier’; many patients with heart failure also have CKD, and patients with both diabetes and early kidney disease may have a reduced life expectancy compared to a healthy person.

Type 2 diabetes is the leading single cause of CKD and end-stage kidney disease in many developed countries.[1,2] The rapidly increasing prevalence of diabetes is a major concern, suggesting that a future rise in CKD is on the horizon. As CKD progresses, it can also be linked with the development of complications; in particular, anemia of CKD can significantly add to both the human and economic burden of disease and is associated with increased mortality, cardiovascular complications and a reduced quality of life [3,4] In the INSIDE CKD project, we aimed to project the future global clinical and economic burden of CKD from 2021 to 2026.

The first question asked, as part of the INSIDE CKD project was, what if current trends stay the same over the next 5-years? The answer is that CKD is currently predicted to pose a significant and increasing economic burden over the next 5 years in all countries studied, including the USA, Canada and the UK.

Looking at data from the USA as an example, we have predicted a 27% increase in the number of people with moderate to severe CKD, from 6.2 to 7.9 million individuals over the next 5 years. By 2026, around 5.8 million of these individuals will also have concomitant type 2 diabetes, a major risk factor for faster progression.[5] The number of people with moderate to severe anemia of CKD is also set to increase by 38%, to 1.6 million people, by 2026.

Between now and 2026, the total cost of managing all aspects of CKD is projected to increase by 17% to $162.89 billion. Half of these costs are associated with end-stage renal disease, illustrating how important it is to halt progression to advanced disease. Broadly similar trends were observed for both Canada and the UK.

The power of microsimulation is that many hypothetical ‘what if’ scenarios can be explored, to understand the future impact they might have before actually being implemented in the real world in order to help inform the optimum course of action to improve health outcomes. In the INSIDE CKD project so far, we have explored the impact of various policy interventions, for example setting up screening programmes to diagnose CKD in its earliest stages. The rationale is that an increase in the diagnosis of early-stage CKD will mean that many more individuals will receive early and proactive treatment, designed to reduce their rate of CKD progression, leading to better outcomes and reduced burden of CKD. The microsimulation method has allowed us to explore in granular detail the predicted effect of these different scenarios and their impact on specific outcomes, answering questions such as: will this new policy reduce the need for dialysis and kidney transplant? And will it reduce healthcare expenditure?

The results of our modelling have shown that these interventions have enormous potential to reduce the burden of CKD. For example, in the US, we have predicted that policies designed to improve screening for CKD could increase the diagnosis of early-stage CKD in around 600,000 individuals over the next 5-years, meaning that these individuals could receive early and proactive treatment. The model has also predicted a corresponding decrease in the prevalence of moderate to severe CKD year-on-year owing to the prevention of CKD progression by proactive management, permitted by earlier diagnosis. The INSIDE Anemia of CKD project is the first microsimulation model to project the impact of interventions aimed at reducing the prevalence of moderate to severe anemia of CKD in the US. This information is invaluable to support and direct policy-makers who are looking to improve outcomes in this area of medicine.

These results were recently presented at virtual congresses held by the European Renal Association – European Dialysis and Transplant Association (ERA-EDTA) and the American Diabetes Association (ADA). Details are shown below:

Conference Abstract number Title
ERA-EDTA 2021 – virtual congress


5–8 June 2021

MO518 Inside CKD – modelling the economic burden of chronic kidney disease in the Americas and the Asia-Pacific region using patient-level microsimulation: results from Canada and the US
MO486 Inside CKD – modelling the impact of improved screening for chronic kidney disease in the Americas and Asia-Pacific region: results from Canada and the US


MO545 Inside ANEMIA of CKD: estimating the impact of policy interventions on anemia of CKD in the US by microsimulation modelling


ADA 2021 – virtual congress


25–29 June 2021


817-P Inside CKD: Modelling the Direct Economic Burden of Concomitant Chronic Kidney Disease and Type 2 Diabetes: Results from the UK and the US


1051-P Inside CKD: Modelling the Future Global Burden of Chronic Kidney Disease in Patients with Type 2 Diabetes: Results from the UK and the US


1028-P Inside CKD: Modelling the Clinical Impact of Targeted Urinary Albumin-to-creatinine Ratio Screening in People with Type 2 Diabetes Across the Globe: Results from the UK and the US


ADA, American Diabetes Association ; CKD, chronic kidney disease; ERA-EDTA, European Renal Association – European Dialysis and Transplant Association.


To access the original abstracts please refer to the congress abstracts for ERA-EDTA 2021 or ADA 2021.


  1. Reutens AT. Med Clin North Am. 2013;97:1–18.
  2. Gorriz JL et al. J Clin Med. 2020;9:947.
  3. Spinowitz E et al. J Med Econ 2019;22:593–604
  4. Van Haalen H et al. BMC Nephrol 2020;21:88
  5. Alicic RZ et al. Clin J Am Soc Nephrol. 2017;12:2032–45.

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