Néphrologie et dialyse, Centre Hospitalier Le Mans, 194 Avenue Rubillard, Le Mans, France.
Laboratory "Movement, Interactions, Performance" (EA 4334), Le Mans University, Le Mans, France.
Nephrol Dial Transplant. 2023 Jan 23;38(1):148-157. doi: 10.1093/ndt/gfac051.
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.
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.
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%).
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.
即使在早期阶段，慢性肾脏病（CKD）也与不良妊娠结局有关。目前的妊娠管理指南建议识别不良结局的风险因素，但没有提到肾脏疾病。由于 CKD 通常无症状，因此妊娠为诊断提供了宝贵的机会。本分析尝试量化将血清肌酐添加到产前筛查和监测测试中的成本。
我们构建的决策树考虑了几种筛查方案（妊娠前、妊娠中和妊娠后），假设每 750 名孕妇中就有 1 名患有 4-5 期 CKD，每 375 名孕妇患有 3B 期 CKD，但只有 50%的 CKD 病例是已知的。流产/流产的患病率计算为 30%；假设妊娠前和妊娠后检测的依从性为 50%，妊娠期间为 90%（流产为 30%）；血清肌酐的成本（生产成本）设定为 0.20 欧元。还提供了一个可下载的计算器，可根据其他设置调整这些数字。
每例检测到的 CKD 病例的成本范围从 111 欧元（妊娠期间进行一次检测，诊断率为 64.8%）到 281.90 欧元（每个妊娠期间进行一次检测，加上一次妊娠后或流产后检测，诊断率为 87.7%）。最佳策略被确定为一次妊娠前、一次妊娠中和一次妊娠后检测（191.80 欧元，诊断率为 89.4%）。
本研究表明，通过将血清肌酐添加到常规进行的产前检查中，可以在妊娠期间早期诊断 CKD，并提供了进一步讨论的成本估计。
