Background Chronic Kidney Disease (CKD) is a leading public health problem, with substantial burden on and economic implications for healthcare systems, mainly from renal replacement treatment (RRT) for End-Stage Kidney Disease (ESKD). In Chile, the prevalence of CKD Stages 1 to 5 in people aged 40 years or older is at least 15.4%, with an increasing rate of adults receiving RRT. The aim of this study is to develop a model to estimate the future burden of the disease in Chile, given the high and rising prevalence of comorbidities for CKD.

Methods A dynamic deterministic Markov model was developed to simulate CKD in the Chilean population aged 40+ from the perspective of the Chilean public healthcare system, up to the year 2070. Key parameters: prevalence of CKD by stages, prevalence of hypertension and diabetes, mortality rate and direct costs of treatment, were extracted from nationally-representative Chilean data. Incidence of the disease and progression rates were simulated based on the most relevant international evidence. The model included seven states replicating the natural progression of the disease: from CKD Stage 2 through to Stage 5, ESKD with need of RRT, and death. The progression of CKD was assumed in 1-year cycles and was categorised as slow and fast progression (decrease in the estimated glomerular filtration rate of 3 ml/min/year or 8 ml/min/year, respectively). At the end of each cycle, a proportion of individuals remained in the same state, progressed to the next CKD stage, began RRT or died. We calibrated the model based on international evidence and conducted one-way sensitivity analyses by varying key model parameters to create different scenarios. We used Stata V15.1 (StataCorp, College Station, Texas, USA) to estimate the model parameters and Microsoft Excel Office 365 V2001 was used to construct the Markov model.

Results By the year 2070, there is an expected increase in the number of adults with ESKD, ceteris paribus, from 22,300 to 58,000 people, with an expected increase in direct costs of CKD stages 2–5 from £213 million to £506 million. A reduction in the percentage of fast progressors could reduce the total cases of ESKD to 42,933 and the expected direct costs by around £110 million.

Conclusion The estimates in this study show an important increase in the cases and costs of CKD. This model can be a useful tool for healthcare planning, with development of preventive or treatment plans to reduce and delay the progression of the disease.