Blanchette Christopher M, Craver Christopher, Belk Kathy W, Lubeck Deborah P, Rossetti Sandro, Gutierrez Benjamin
University of North Carolina , Charlotte, NC , USA.
J Med Econ. 2015 Apr;18(4):303-11. doi: 10.3111/13696998.2014.985381. Epub 2015 Jan 20.
Polycystic kidney disease (PKD) is a clinically and genetically heterogeneous class of genetic disorders characterized by development of renal cysts leading to renal failure and end stage renal disease (ESRD). Autosomal dominant polycystic kidney disease (ADPKD) accounts for the majority of PKD cases and is the predominant monogenic cause of ESRD. Limited information on patient characteristics and healthcare resource utilization is available in this population. This study assessed hospital-based inpatient utilization of patients with ADPKD in the US to help further understand the disease, which may lead to treatments that delay progression and reduce healthcare resource utilization.
A cross-sectional analysis was conducted using MedAssets Health System Data to investigate inpatient resource utilization for a total of 1876 patients hospitalized with ADPKD or chronic kidney disease (CKD). Patient characteristics and inpatient resource utilization were compared between hospitalized patients with ADPKD and CKD, including demographic and clinical characteristics, overall health, rates of complications and surgical interventions, and average length of hospital and intensive care unit stay.
Compared with patients with CKD, patients with ADPKD were more likely to have commercial insurance as their primary payer (36.1 vs 17.8%) and were significantly younger (mean age 57.9 vs 69.5 years) and generally healthier (Charlson Comorbidity Score of 2.0 vs 3.3). Patients with ADPKD also had a substantially shorter average length of hospital stay (6.3 vs 10.3 days). However, patients with ADPKD experienced more kidney-related complications and a higher surgical procedure rate (mainly for transplant and complete nephrectomy).
Although patients with ADPKD were generally healthier than patients with CKD, specific kidney function complications were more frequent. Patients with ADPKD had a higher rate of major kidney procedures, which may contribute to the high burden of ADPKD-related hospital-based inpatient resource utilization.
多囊肾病（PKD）是一类临床和遗传异质性的遗传疾病，其特征是肾囊肿的形成，最终导致肾衰竭和终末期肾病（ESRD）。常染色体显性遗传多囊肾病（ADPKD）占PKD病例的大多数，是ESRD的主要单基因病因。关于该人群患者特征和医疗资源利用的信息有限。本研究评估了美国ADPKD患者的住院情况，以帮助进一步了解该疾病，这可能会带来延缓疾病进展和减少医疗资源利用的治疗方法。
采用MedAssets卫生系统数据进行横断面分析，调查了1876例因ADPKD或慢性肾病（CKD）住院患者的住院资源利用情况。比较了ADPKD和CKD住院患者的患者特征和住院资源利用情况，包括人口统计学和临床特征、总体健康状况、并发症和手术干预率，以及平均住院时间和重症监护病房停留时间。
与CKD患者相比，ADPKD患者更有可能以商业保险作为主要支付方（36.1%对17.8%），且年龄显著更小（平均年龄57.9岁对69.5岁），总体健康状况更好（Charlson合并症评分2.0对3.3）。ADPKD患者的平均住院时间也显著更短（6.3天对10.3天）。然而，ADPKD患者出现更多与肾脏相关的并发症和更高的手术率（主要是移植和全肾切除术）。
尽管ADPKD患者总体上比CKD患者更健康，但特定的肾功能并发症更为常见。ADPKD患者的主要肾脏手术率更高，这可能导致与ADPKD相关的住院患者住院资源利用负担较重。
