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Adding creatinine to routine pregnancy tests: a decision tree for calculating the cost of identifying patients with CKD in pregnancy

BACKGROUND: Even in its early stages, chronic kidney disease (CKD) is associated with adverse pregnancy outcomes. The current guidelines for pregnancy management suggest identifying risk factors for adverse outcomes but do not mention kidney diseases. Since CKD is often asymptomatic, pregnancy offer...

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Autores principales: Piccoli, Giorgina Barbara, Chatrenet, Antoine, Cataldo, Manuela, Torreggiani, Massimo, Attini, Rossella, Masturzo, Bianca, Cabiddu, Gianfranca, Versino, Elisabetta
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9869858/
https://www.ncbi.nlm.nih.gov/pubmed/35238937
http://dx.doi.org/10.1093/ndt/gfac051
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author Piccoli, Giorgina Barbara
Chatrenet, Antoine
Cataldo, Manuela
Torreggiani, Massimo
Attini, Rossella
Masturzo, Bianca
Cabiddu, Gianfranca
Versino, Elisabetta
author_facet Piccoli, Giorgina Barbara
Chatrenet, Antoine
Cataldo, Manuela
Torreggiani, Massimo
Attini, Rossella
Masturzo, Bianca
Cabiddu, Gianfranca
Versino, Elisabetta
author_sort Piccoli, Giorgina Barbara
collection PubMed
description BACKGROUND: Even in its early stages, chronic kidney disease (CKD) is associated with adverse pregnancy outcomes. The current guidelines for pregnancy management suggest identifying risk factors for adverse outcomes but do not mention kidney diseases. Since CKD is often asymptomatic, pregnancy offers a valuable opportunity for diagnosis. The present analysis attempts to quantify the cost of adding serum creatinine to prenatal screening and monitoring tests. METHODS: The decision tree we built takes several screening scenarios (before, during and after pregnancy) into consideration, following the hypothesis that while 1:750 pregnant women are affected by stage 4–5 CKD and 1:375 by stage 3B, only 50% of CKD cases are known. Prevalence of abortions/miscarriages was calculated at 30%; compliance with tests was hypothesized at 50% pre- and post-pregnancy and 90% during pregnancy (30% for miscarriages); the cost of serum creatinine (production cost) was set at 0.20 euros. A downloadable calculator, which makes it possible to adapt these figures to other settings, is available. RESULTS: The cost per detected CKD case ranged from 111 euros (one test during pregnancy, diagnostic yield 64.8%) to 281.90 euros (one test per trimester, plus one post-pregnancy or miscarriage, diagnostic yield 87.7%). The best policy is identified as one test pre-, one during and one post-pregnancy (191.80 euros, diagnostic yield 89.4%). CONCLUSIONS: This study suggests the feasibility of early CKD diagnosis in pregnancy by adding serum creatinine to routinely performed prenatal tests and offers cost estimates for further discussion.
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spelling pubmed-98698582023-01-23 Adding creatinine to routine pregnancy tests: a decision tree for calculating the cost of identifying patients with CKD in pregnancy Piccoli, Giorgina Barbara Chatrenet, Antoine Cataldo, Manuela Torreggiani, Massimo Attini, Rossella Masturzo, Bianca Cabiddu, Gianfranca Versino, Elisabetta Nephrol Dial Transplant Original Article BACKGROUND: Even in its early stages, chronic kidney disease (CKD) is associated with adverse pregnancy outcomes. The current guidelines for pregnancy management suggest identifying risk factors for adverse outcomes but do not mention kidney diseases. Since CKD is often asymptomatic, pregnancy offers a valuable opportunity for diagnosis. The present analysis attempts to quantify the cost of adding serum creatinine to prenatal screening and monitoring tests. METHODS: The decision tree we built takes several screening scenarios (before, during and after pregnancy) into consideration, following the hypothesis that while 1:750 pregnant women are affected by stage 4–5 CKD and 1:375 by stage 3B, only 50% of CKD cases are known. Prevalence of abortions/miscarriages was calculated at 30%; compliance with tests was hypothesized at 50% pre- and post-pregnancy and 90% during pregnancy (30% for miscarriages); the cost of serum creatinine (production cost) was set at 0.20 euros. A downloadable calculator, which makes it possible to adapt these figures to other settings, is available. RESULTS: The cost per detected CKD case ranged from 111 euros (one test during pregnancy, diagnostic yield 64.8%) to 281.90 euros (one test per trimester, plus one post-pregnancy or miscarriage, diagnostic yield 87.7%). The best policy is identified as one test pre-, one during and one post-pregnancy (191.80 euros, diagnostic yield 89.4%). CONCLUSIONS: This study suggests the feasibility of early CKD diagnosis in pregnancy by adding serum creatinine to routinely performed prenatal tests and offers cost estimates for further discussion. Oxford University Press 2022-03-03 /pmc/articles/PMC9869858/ /pubmed/35238937 http://dx.doi.org/10.1093/ndt/gfac051 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of the ERA. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Original Article
Piccoli, Giorgina Barbara
Chatrenet, Antoine
Cataldo, Manuela
Torreggiani, Massimo
Attini, Rossella
Masturzo, Bianca
Cabiddu, Gianfranca
Versino, Elisabetta
Adding creatinine to routine pregnancy tests: a decision tree for calculating the cost of identifying patients with CKD in pregnancy
title Adding creatinine to routine pregnancy tests: a decision tree for calculating the cost of identifying patients with CKD in pregnancy
title_full Adding creatinine to routine pregnancy tests: a decision tree for calculating the cost of identifying patients with CKD in pregnancy
title_fullStr Adding creatinine to routine pregnancy tests: a decision tree for calculating the cost of identifying patients with CKD in pregnancy
title_full_unstemmed Adding creatinine to routine pregnancy tests: a decision tree for calculating the cost of identifying patients with CKD in pregnancy
title_short Adding creatinine to routine pregnancy tests: a decision tree for calculating the cost of identifying patients with CKD in pregnancy
title_sort adding creatinine to routine pregnancy tests: a decision tree for calculating the cost of identifying patients with ckd in pregnancy
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9869858/
https://www.ncbi.nlm.nih.gov/pubmed/35238937
http://dx.doi.org/10.1093/ndt/gfac051
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