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

Abstract

Background Even in its early stages, 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 hypotheses that while 1:750 pregnant woman is 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.

Pre-gestational counselling for women living with CKD: starting from the bright side

“…Since serum creatinine is not included in health screening before and during pregnancy, CKD is often diagnosed only when a woman develops complications in pregnancy [ 31 , 32 ]. Hence, some experts hold that serum creatinine should be included in the basic pregnancy tests [ 40 ].…”

Access to Nephrology Care for Pregnancy-Related Acute Kidney Injury in Low- and Lower-Middle-Income Countries: A Perspective

“…Screening policies with integration of serum creatinine, a basic low-cost marker of kidney function, in the routine work-up for pregnant patients has been largely advocated by the nephrology community. 34 Moreover, postnatal screening is increasingly required in women who experience pregnancy complications. Special long-term screening programs should target women with prior episodes of pregnancy-related AKI and hypertensive disorders of pregnancy for early diagnosis of chronic kidney disease.…”

Roadmaps to green nephrology: a mediterranean point of view

“…Even projects suggesting the inclusion of simple low-cost tests, such as serum creatinine, in particular populations fail to be implemented because of allegedly high costs, without considering that the consequences of a late diagnosis are more expensive. Moreover, going through past medical histories to select patients who should measure biological data is extremely costly in terms of expert time [51].…”