Screening for acquired cystic kidney disease: a decision analytic perspective.
Acquired cystic kidney disease (ACKD) increases the risk of renal malignancy, and many authors suggest routine screening of dialysis patients for ACKD and renal tumors. However, they have defined neither the target population, the optimal screening strategy, the magnitude of its benefit, nor its risk. We used decision analysis to evaluate strategies of performing either computed tomography (CT) or ultrasound every three years on all dialysis patients and annually on patients found to have cysts. We compared these strategies to a strategy of seeking cysts and cancer only if these are clinically suspected. The baseline analysis shows that both CT and ultrasound may decrease cancer deaths by half for patients with a life expectancy of 25 years. Screening for ACKD offers these patients as much as a 1.6 year gain in life expectancy. However, for the majority of patients beginning renal replacement therapy, age or comorbid disease substantially limits life expectancy. For such patients, the gain in life expectancy from an ACKD screening program is measured in days. Sensitivity analyses show that the benefit of screening depends on the rate of malignant transformation, which needs better definition. The gain in life expectancy does not appear to be large enough to justify an ACKD screening program for the entire ESRD population. However, for the youngest and healthiest patients, a screening program would be of benefit. The magnitude of this benefit is uncertain, because the analysis was consistently biased in favor of the screening strategies.
Sarasin
F P
FP
Division of Clinical Decision Making, New England Medical Center Hospitals, Boston, Massachusetts, USA.
Wong
J B
JB
Levey
A S
AS
Meyer
K B
KB
D003661:Decision Support Techniques; D003663:Decision Trees; D006801:Humans; D052177:Kidney Diseases, Cystic / Q000150:complications / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D007676:Kidney Failure, Chronic / Q000150:complications*; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000209:etiology / Q000401:mortality*; D008017:Life Expectancy; D016014:Linear Models; D008390:Markov Chains; D008403:Mass Screening; D011159:Population Surveillance; D006435:Renal Dialysis; D012680:Sensitivity and Specificity; D016019:Survival Analysis