Sanon Aigbogun Myrlene, Stellhorn Robert A, Pao Christina S, Seliger Stephen L
Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ, USA.
University of Maryland School of Medicine, Baltimore, MD, USA.
Int J Nephrol Renovasc Dis. 2021 May 7;14:133-142. doi: 10.2147/IJNRD.S300331. eCollection 2021.
Progression of autosomal dominant polycystic kidney disease (ADPKD) is highly variable, with some patients progressing rapidly to end-stage renal disease (ESRD). Abdominal imaging is an important modality for verifying diagnosis in patients at risk for rapidly progressing ADPKD, targeting them for early treatment that could slow onset of ESRD. Published literature is limited on the real-world abdominal imaging utilization patterns in ADPKD.
A retrospective healthcare administrative claims analysis examining abdominal imaging scans occurring from January 1, 2014, through June 30, 2017, was conducted using the IBM MarketScan commercial and Medicare supplemental databases. Patients in the United States who were at least 18 years old and had at least 1 inpatient claim or 2 outpatient claims (with different dates of service) with an ADPKD diagnosis code, as defined by the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM codes 753.12 [polycystic kidney, unspecified type] and 753.13 [polycystic kidney, autosomal dominant] and/or Tenth Revision (ICD-10-CM codes Q61.2 [polycystic kidney, adult type] and Q61.3 [polycystic kidney, unspecified]) were included.
Of the 4637 patients with ADPKD (mean age, 51.2 years [SD = 15.52]), 59% had ≥1 abdominal imaging scan. Of these patients, 46% had ≥1 computed tomography (CT) scan, 25% had ≥1 ultrasound, 10% had ≥1 magnetic resonance imaging scan. Among the 1754 patients (38%) with chronic kidney disease (CKD) stage information, CT imaging was more frequent in later stages (31% stage 1 versus 68% stage 5). The proportion of patients undergoing at least 1 CT or MRI scan increased with disease severity (37% in stage 1, 42% in stage 2, 48% in stage 3, 56% in stage 4, and 71% in stage 5).
Results of this analysis support the need for further investigation into abdominal imaging utilization in managing patients with ADPKD. Future research could clarify barriers and increase access to imaging, which has the potential to inform risk stratification, help patients delay dialysis or transplantation associated with ESRD, and help health systems avoid the costs associated with ESRD.
常染色体显性遗传性多囊肾病（ADPKD）的病情进展差异很大，一些患者会迅速发展为终末期肾病（ESRD）。腹部影像学检查是确诊快速进展性ADPKD高危患者的重要手段，可针对这些患者进行早期治疗，从而延缓ESRD的发病。关于ADPKD患者实际腹部影像学检查应用模式的已发表文献有限。
利用IBM MarketScan商业数据库和医疗保险补充数据库，对2014年1月1日至2017年6月30日期间进行的腹部影像学扫描进行回顾性医疗管理索赔分析。纳入美国至少18岁、有至少1次住院索赔或2次门诊索赔（服务日期不同）且诊断代码符合国际疾病分类第九版临床修订本（ICD-9-CM代码753.12[未指定类型的多囊肾]和753.13[常染色体显性遗传性多囊肾]）和/或第十版（ICD-10-CM代码Q61.2[成人型多囊肾]和Q61.3[未指定的多囊肾]）的ADPKD患者。
在4637例ADPKD患者（平均年龄51.2岁[标准差=15.52]）中，59%进行了≥1次腹部影像学检查。在这些患者中，46%进行了≥1次计算机断层扫描（CT），25%进行了≥1次超声检查，10%进行了≥1次磁共振成像扫描。在1754例（38%）有慢性肾脏病（CKD）分期信息的患者中，CT成像在疾病后期更为常见（1期为31%，5期为68%）。接受至少1次CT或MRI扫描的患者比例随疾病严重程度增加（1期为37%，2期为42%，3期为48%，4期为56%，5期为71%）。
本分析结果支持对ADPKD患者腹部影像学检查应用情况进行进一步研究。未来的研究可以明确障碍并增加影像学检查的可及性，这有可能为风险分层提供信息，帮助患者推迟与ESRD相关的透析或移植，并帮助卫生系统避免与ESRD相关的费用。
