Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jan 23;38(1):148-157.
doi: 10.1093/ndt/gfac051.

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

Giorgina Barbara Piccoli  1 , Antoine Chatrenet  1   2 , Manuela Cataldo  3 , Massimo Torreggiani  1 , Rossella Attini  4 , Bianca Masturzo  4 , Gianfranca Cabiddu  5 , Elisabetta Versino  6 ; Kidney and Pregnancy Study Group of the Italian Society of Nephrology
Collaborators, Affiliations

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

Giorgina Barbara Piccoli et al. Nephrol Dial Transplant. .

Abstract

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.

Keywords: chronic kidney disease; hypertensive disorders of pregnancy; pre-term delivery; preeclampsia; screening.

PubMed Disclaimer

Figures

Graphical Abstract
Graphical Abstract
FIGURE 1:
FIGURE 1:
Flow-chart of the main assumptions leading to the identification of the number of cases that would be found.
FIGURE 2:
FIGURE 2:
Cost per new diagnosis, assuming a production cost of serum creatinine of 0.20 euros per test.
FIGURE 3:
FIGURE 3:
Flow chart displaying the diagnostic yield at each step in the most favourable scenario 6, combining tests before, during and after pregnancy.
FIGURE 4:
FIGURE 4:
Sensitivity analysis for scenario 6. CKD, chronic kidney disease. The input parameters are reported in Table 1.
FIGURE 5:
FIGURE 5:
Input page of the downloadable calculator.
See this image and copyright information in PMC

References

    1. Zhang JJ, Ma XX, Hao Let al. . A systematic review and meta-analysis of outcomes of pregnancy in CKD and CKD outcomes in pregnancy. Clin J Am Soc Nephrol 2015; 10: 1964–1978 - PMC - PubMed
    1. Nevis IF, Reitsma A, Dominic Aet al. . Pregnancy outcomes in women with chronic kidney disease: a systematic review. Clin J Am Soc Nephrol 2011; 6: 2587–2598 - PMC - PubMed
    1. Piccoli GB, Cabiddu G, Attini Ret al. . Risk of adverse pregnancy outcomes in women with CKD. J Am Soc Nephrol 2015; 26: 2011–2022 - PMC - PubMed
    1. Istituto Superiore di Sanità . Gravidanza fisiologica [Physiological pregnancy]. https://www.salute.gov.it/imgs/C_17_pubblicazioni_1436_allegato.pdf (10 October 2021, date last accessed)
    1. Haute Autorité de Santé . Suivi et orientation des femmes enceintes en fonction des situations à risque identifiées [Follow-up and management of pregnant women according to identified risks]. https://www.has-sante.fr/portail/jcms/c_547976/fr/suivi-et-orientation-d... (10 October 2021, date last accessed) - PubMed

Grants and funding