Seasonal patterns, fate and ecological risk assessment of pharmaceutical compounds in a wastewater treatment plant with Bacillus bio-reactor treatment.

Pharmaceutical compounds (PhCs) pose a growing concern with potential environmental impacts, commonly introduced into the environment via wastewater treatment plants (WWTPs). The occurrence, removal, and season variations of 60 different classes of PhCs were investigated in the baffled bioreactor (BBR) wastewater treatment process during summer and winter. The concentrations of 60 PhCs were 3400 ± 1600 ng/L in the influent, 2700 ± 930 ng/L in the effluent, and 2400 ± 120 ng/g dw in sludge. Valsartan (Val, 1800 ng/L) was the main contaminant found in the influent, declining to 520 ng/L in the effluent. The grit chamber and BBR tank were substantially conducive to the removal of VAL. Nonetheless, the BBR process showcased variable removal efficiencies across different PhC classes. Sulfadimidine had the highest removal efficiency of 87 ± 17% in the final effluent (water plus solid phase). Contrasting seasonal patterns were observed among PhC classes within BBR process units. The concentrations of many PhCs were higher in summer than in winter, while some macrolide antibiotics exhibited opposing seasonal fluctuations. A thorough mass balance analysis revealed quinolone and sulfonamide antibiotics were primarily eliminated through degradation and transformation in the BBR process. Conversely, 40.2 g/d of macrolide antibiotics was released to the natural aquatic environment via effluent discharge. Gastric acid and anticoagulants, as well as cardiovascular PhCs, primarily experienced removal through sludge adsorption. This study provides valuable insights into the intricate dynamics of PhCs in wastewater treatment, emphasizing the need for tailored strategies to effectively mitigate their release and potential environmental risks.

The role of digital finance for the growth of renewable energy: evidence from China.

Developing renewable energy (RE) is the inevitable choice for China to achieve its climate goals. However, financing RE investments remains challenging. Meanwhile, China's digital finance (DF) is profoundly influencing the trajectory of the energy transition. This study empirically investigates the role of DF on the growth of RE, what aspects of DF matter, and its geographical attenuation process, taking both spatial and temporal dimensions into consideration. The empirical results show that DF and its coverage breadth and usage depth can facilitate RE development in both local and neighboring regions, with a comparatively limited effect of digitalization level. The impact of DF on the growth of RE is heterogeneous and has been declining over time. Specifically, this effect is observable only in the eastern regions. The spillover effects of DF on RE development vary in different spatial thresholds, which has clear boundary effects and geographical decay characteristics.

Spatiotemporal variations in soil pollution by polycyclic aromatic hydrocarbons over a 20-year economic boom in different districts of a heavy industrial city in North China.

Urbanization-related human activities, such as population aggregation, rapid industrial expansion, and intensified traffic, are key factors that impact local polycyclic aromatic hydrocarbon emissions and their associated health risks. Consequently, regions with varying degrees of urbanization within a megacity may exhibit diverse spatiotemporal patterns in the presence and distribution of soil polycyclic aromatic hydrocarbons, resulting in different levels of ecological risks for local inhabitants following the same period of development. In this study, we measured the concentrations of 16 polycyclic aromatic hydrocarbons in soil samples collected from industrial district and rural district in Tianjin (China) in 2018, and compared with polycyclic aromatic hydrocarbon data in 2001 from a previous study to characterize these regional variations in occurrence, source, and human risk of polycyclic aromatic hydrocarbons induced by urbanization with time and space. The results indicate the 20-year rapid urbanization and industrialization has differentially affected the composition, distribution and sources of polycyclic aromatic hydrocarbons in soils from different economic functional zones in Tianjin. Additionally, its impact on health risks in rural district appeared to be more significant than that in industrial district.

Distribution, sources and risk assessment of polycyclic aromatic hydrocarbons in surface sediments from the Yellow Sea coast, China.

To study the distribution, sources, ecological/health risks, and the impact of regional economic variations on polycyclic aromatic hydrocarbons (PAHs) contaminations along the coast of the Yellow Sea in China, sediments from a broad coastal coverage were collected and analyzed. The total contents of 16 priority PAHs varied between 1.4 and 1675.9 ng/g except in the site of H18 (3191.4 ng/g) adjacent to Qingdao City, with an average value of 295.7 ng/g. PAH pollution along the coast presented a distinctive geographical feature, which was closely linked to local human activities, such as Rongcheng with industrial zones and aquacultural areas, and Yancheng Wetland with developed aquaculture. The source analysis results indicated that PAHs were mainly from pyrolytic sources, with smaller contributions from petroleum spills and combustion. Risk assessment suggested that PAH pollution along the Yellow Sea coast showed negligible biological risks and health risks in most areas.

Influence of green finance on carbon emission intensity: empirical evidence from China based on spatial metrology.

Based on the panel data of 30 provinces in China from 2011 to 2020, this paper empirically examines the direct effect, spatial spillover effect, and total effect of green finance on carbon emission intensity through the spatial econometric model, considering both spatial and temporal patterns. The results show the following: (1) The carbon emission intensity of each province in China shows a noticeable spatial spillover effect and a positive spatial correlation distribution of "high-high" and "low-low" agglomeration. (2) The development of green finance in China is interrelated but uneven in space, which presents a gradient strengthening trend from the west to the east. (3) Green finance development will curb the intensity of carbon emissions, and this effect has gradually been increasing over time and differs by region. Specifically, green finance will increase the carbon emission intensity of adjacent areas in the short term but will significantly reduce the local province's carbon emission intensity to a larger extent. Finally, it puts forward policy recommendations to promote the coordinated development of green finance and a low-carbon economy.

Economics of planning electricity transmission considering environmental and health externalities.

Long-distance electricity transmission can achieve environmental benefits through the transfer of air pollutants. However, current electricity transmission investment decisions do not take enough environmental factors into account. This study combines Greenhouse Gas-Air Pollution Interactions and Synergies model with power system planning to reveal how regional differences in environmental and health losses affect the allocation of electricity at the spatial level. Based on the analysis of inter-provincial electricity interconnection in China, we find that the regional differences in environmental and health external costs of power generation are significant. Considering external costs in investment decisions will largely improve the economy of long-distance inter-regional electricity transfer dominated by ultra-high voltage lines, thus replacing a portion of intra-regional electricity transfer dominated by high voltage lines. Meanwhile, the increases in local health losses in major electricity exporting provinces are not significant, which can alleviate the regional equity issues caused by pollutant transfer.

Development and validation of MRI-based radiomics signatures as new markers for preoperative assessment of EGFR mutation and subtypes from bone metastases.

BACKGROUND: This study aimed to develop and externally validate contrast-enhanced (CE) T1-weighted MRI-based radiomics for the identification of epidermal growth factor receptor (EGFR) mutation, exon-19 deletion and exon-21 L858R mutation from MR imaging of spinal bone metastasis from primary lung adenocarcinoma. METHODS: A total of 159 patients from our hospital between January 2017 and September 2021 formed a primary set, and 24 patients from another center between January 2017 and October 2021 formed an independent validation set. Radiomics features were extracted from the CET1 MRI using the Pyradiomics method. The least absolute shrinkage and selection operator (LASSO) regression was applied for selecting the most predictive features. Radiomics signatures (RSs) were developed based on the primary training set to predict EGFR mutations and differentiate between exon-19 deletion and exon-21 L858R. The RSs were validated on the internal and external validation sets using the Receiver Operating Characteristic (ROC) curve analysis. RESULTS: Eight, three, and five most predictive features were selected to build RS-EGFR, RS-19, and RS-21 for predicting EGFR mutation, exon-19 deletion and exon-21 L858R, respectively. The RSs generated favorable prediction efficacies for the primary (AUCs, RS-EGFR vs. RS-19 vs. RS-21, 0.851 vs. 0.816 vs. 0.814) and external validation (AUCs, RS-EGFR vs. RS-19 vs. RS-21, 0.807 vs. 0.742 vs. 0.792) sets. CONCLUSIONS: Radiomics features from the CE MRI could be used to detect the EGFR mutation, increasing the certainty of identifying exon-19 deletion and exon-21 L858R mutations based on spinal metastasis MR imaging.

Using green finance to counteract the adverse effects of COVID-19 pandemic on renewable energy investment-The case of offshore wind power in China.

The outbreak of COVID-19 pandemic has increased the production costs of renewable energy facilities and undermines the profitability of renewable energy investment. Green finance polices, e.g. carbon pricing, tradable green certificate (TGC) and green credit, can provide low-cost finances and counteract the adverse effects of COVID-19 pandemic. In this work, the generation costs of offshore wind power before and after the COVID-19 pandemic in China are analyzed using the data of 97 offshore wind power projects implemented in the period of 2014-2020, and the effect of green finance policy on the generation cost and the project profitability are evaluated. The results show that the average levelized cost of electricity (LCOE) of offshore wind power decreased from 0.86 CNY/kWh in 2014 to 0.72 CNY/kWh in 2019, while it increased to 0.79 CNY/kWh in 2020, i.e. 10.85% increase relative to that in 2019. With the average carbon price of 50 CNY/t CO2, the average TGC price of 170 CNY and the green-credit policy being introduced, the average LCOE decreases to 0.76 CNY/kWh, 0.67 CNY/kWh and 0.74 CNY/kWh respectively. The green finance policy mix is still necessary to support the offshore wind power investment during the Covid-19 pandemic.

Assessment of racial differences in the incidence of thrombocytopenia induced by trastuzumab emtansine: a systematic review and meta-analysis.

BACKGROUND: Trastuzumab emtansine (T-DM1) has been proved to have value and efficacy in the treatment of advanced metastatic cancer, including in the adjuvant setting. However, there is increasing concern about T-DM1-induced thrombocytopenia (TCP), which shows racial differences in incidence. This meta-analysis aimed to evaluate differences in the incidence of T-DM1-related TCP between Asian and non-Asian patients by combining accessible information from all single-agent T-DM1 clinical trials published to date. METHODS: We conducted systematic searches of the PubMed, Embase, and the Cochrane Library databases to identify relevant clinical studies of T-DM1 that reported on safety, including the incidence of TCP, which were published between January 1980 and March 2020. Two reviewers were responsible for the screening and extraction of data. The pooled-effect estimate calculated with a fixed-effects or random-effects model was represented as incidence with 95% confidence intervals (CIs). RESULTS: A total of 29 studies involving 6,188 patients were included. The incidence of all-grade TCP in Asian patients and non-Asian patients was 0.39 (95% CI: 0.11-0.67) and 0.29 (95% CI: 0.23-0.35), respectively. The incidence of TCP of grade 3 or higher in Asians was 0.20 (95% CI: 0.10-0.29), compared with 0.02 (95% CI: 0.01-0.03) in non-Asians. Gastrointestinal cancer type and a T-DM1 treatment dose of 2.4 mg/kg Q3W were related to grade 3 or higher TCP events. DISCUSSION: Asian patients have a higher risk of developing TCP after receiving T-DM1 than non-Asian patients. Clinicians should be aware of the importance of careful observation of platelet count in patients receiving T-DM1 therapy.

The role of national carbon pricing in phasing out China's coal power.

As the country with the world's largest coal power capacity, China is launching a national carbon market. How the carbon pricing may contribute to phasing out China's coal power is a great concern. We collect full-sample data set of China's 4540 operating coal plant units and develop a stochastic Monte-Carlo financial model to assess the financial sustainability of the plant operation. Although China's coal plants have long residual technical lifetime, their operations are close to the break-even state. Even with low carbon price of 50 CNY/tCO2 growing at 4%/y and the permits being fully auctioned, the average residual lifetime of all the plants will be reduced by 5.43 years, and the cumulative CO2 emission from 2020 to 2050 will be reduced by 22.73 billion ton. The spatial disparity in the carbon pricing effect is significant, and the western regions are more vulnerable to the carbon pricing risk than the eastern regions.

An Endowment Effect Study in the European Union Emission Trading Market based on Trading Price and Price Fluctuation.

This paper pioneers to investigate the endowment effect in the European Union mission Trading Scheme (EU ETS) as well as the impacts of trading experience and compliance pressure on the endowment effect. This study is based on the complete transaction records of the market. In the data set, the records of two consecutive reverse transactions from a same emitting company are selected. The lowest price that the buyer is willing to pay (WTP) and the maximum price the seller is willing to accept (WTA) are evaluated by excluding their risk cost that is used to avoid short-term fluctuations in the price. By distinguishing the difference between WTA and WTP, and long-term fluctuations in the prices during the two transactions, the trader's endowment effect can be quantitively assessed. The results show that the degree of endowment effect of traders follows the trading experience. In addition, since the EU ETS is a cap-and-trade market, the traders face different levels of compliance pressure; when the pressure of the emission companies increases, the degree of endowment effect will also decrease.

Plasma D-dimer as a predictor of intraluminal thrombus burden and progression of abdominal aortic aneurysm.

AIM: Intraluminal thrombus (ILT) is presented in most abdominal aortic aneurysms (AAAs) and is suggested to promote AAA expansion. D-dimer, a breakdown product in the thrombus remodeling, may have prognostic value for AAA. This study investigated the interrelation between plasma D-dimer level, ILT volume, AAA size and progression. MAIN METHODS: This was a retrospective observational study that involved 181 patients with infra-renal AAA. They were divided into small and large AAA groups according to AAA diameter. 24 of them had repeated abdominal computed tomography angiography (CTA) scan and were divided into slow-growing and fast-growing AAA groups according to the median value of AAA growth rate. Baseline and follow-up plasma D-dimer level, maximum diameter of AAA, total infra-renal aortic volume and ILT volume were analyzed. KEY FINDINGS: Plasma D-dimer level was positively correlated with ILT volume (R = 0.382, P < 0.001) and maximum diameter of AAA (R = 0.442, P < 0.001). Increasing value of plasma D-dimer was positively associated with the accelerated growth rate of AAA (R = 0.720, P < 0.01). ILT volume showed positive correlation with maximum diameter (R = 0.859, P < 0.001) and growth rate of AAA (R = 0.490, P < 0.05). After adjusting the baseline ILT volume, the positive correlations remained to be statistically significant between plasma D-dimer level and AAA size (R = 0.200, P < 0.05), as well as increasing value of plasma D-dimer and growth rate of AAA (R = 0.642, P < 0.05). SIGNIFICANCE: Plasma D-dimer level reflected ILT burden in AAAs. Plasma D-dimer level and ILT volume were positively correlated with AAA size. Increasing value of plasma D-dimer and baseline ILT volume could be predictors of AAA progression.

Toxicity assessment due to prenatal and lactational exposure to lead, cadmium and mercury mixtures.

The heavy metals lead (Pb), cadmium (Cd) and mercury (Hg) are common environmental pollutants that can be detected simultaneously in blood, serum, and urine samples from the general human population. However, there is limited information regarding toxicity of low-level exposure to Pb, Cd, and Hg mixtures. Our previous research showed the interaction of these three elements at low concentrations in vitro. In this study, we further evaluate early effects of low dose exposure to Pb, Cd, and Hg mixtures on the brain, heart, liver, kidney, and testicle in rats. Pregnant rats were exposed to various concentrations of heavy metal mixtures (MM) in drinking water, during gestation and lactation, and the impacts on offspring were measured at postnatal day 23. Our results showed that the concentrations of Pb, Cd, and Hg in the blood of rat pups were similar to those in the blood of the general human population. Additionally, the MM concentrations in their blood and brain significantly increased in a dose-dependent manner. MM exposure caused histopathological changes in the brain, liver, kidney and testicle. Statistically significant increases in liver CYP450 and PON1, kidney KIM1, and decrease in testicle SDH were observed. In the brain, significant increases were detected in oxidative stress, intracellular free calcium, and cell apoptosis. Further neurobehavioral testing revealed that MM exposure caused dose-dependent impairments in learning and memory as well as sensory perception. MM exposure also disrupted synapse remodeling, which may be associated with pathways involved in dendritic spine growth, maintenance, and elimination. These results suggested that exposure to Pb, Cd, and Hg mixtures, at human environmental exposure related levels, caused damage to multiple organs as well as impairments in neurobehavioral functions of rats. Our findings emphasize the need to control and regulate potential sources of heavy metal contamination.

Is the mean platelet volume a predictive marker of a high in-hospital mortality of acute cardiorenal syndrome patients receiving continuous renal replacement therapy?

A high mean platelet volume (MPV) level has been demonstrated to predict poor clinical outcomes in patients with cardiovascular disease. However, the relationship between MPV and mortality in patients with acute cardiorenal syndrome (ACRS) is unknown. Therefore, we investigated the predictive value of MPV for in-hospital mortality of patients with ACRS who received continuous renal replacement therapy (CRRT) in this study.We retrospectively analyzed the demographics, etiology, severity of illness, prognosis, and risk factors of ACRS patients who underwent CRRT in our hospital from January 2009 to December 2014. Patients were classified into 2 groups based on the prognosis and timing of CRRT. The receiver operating characteristic curve was used to examine the performance of MPV in predicting in-hospital mortality. Baseline characteristics, clinical, and hematological parameters at CRRT initiation were compared between the 2 groups. Factors influencing in-hospital mortality were analyzed by univariate logistic regression analysis.The median age of patients was 74 years. Acute myocardial infarction was the most common cause of ACRS, followed by acute decompensated heart failure. The in-hospital mortality was 51.4%. Age, number of organ failure, APACHE II score, and MPV in the nonsurvivors were significantly higher than those in the survivors (P < .05). However, the cardiac function and mean arterial pressure were significantly lower in the nonsurvivors (P < .05). The prognosis of the early intervention group was better than the late-intervention group, but no significant difference was found (P > .05). The area under the curve (AUC) for in hospital mortality based on MPV was 0.735. Univariate analysis showed that age, cardiac function NYHA class, number of organ failure, APACHE II score, MAP, MPV, and use of vasopressors were associated with the prognosis of patients (P < .05).These findings suggest that the prognosis of patients with ACRS who received CRRT was poor, and MPV might be useful as a marker for predicting the in-hospital mortality of these patients.

Is the ratio of apoB/apoA-1 the best predictor for the severity of coronary artery lesions in Chinese diabetics with stable angina pectoris? An assessment based on Gensini scores.

BACKGROUND: There is a paucity of data about the best lipid ratio predicting the severity of coronary artery disease (CAD) in patients with diabetes mellitus. We determined the relationship between five conventional lipid ratios and the extent of coronary artery lesions in Chinese Type 2 diabetics with stable angina pectoris (SAP). METHODS: A prospective cohort study within 373 type 2 diabetic patients diagnosed with stable CAD by coronary angiography was performed. All patients were classified into three groups according to the tertiles of Gensini scores (GS, low group < 8 points n = 143; intermediate group 8-28 points, n = 109; high group > 28 points, n = 121). Association between the ratios of apolipoprotein (apo) B and apoA-1, total cholesterol and high density lipoprotein cholesterol (TC/HDL-C), triglycerides and HDL-C (TG/HDL-C), low density lipoprotein cholesterol and HDL-C (LDL-C/HDL-C), Non-HDL-C/HDL-C and GS were evaluated using the receivers operating characteristic (ROC) curves and multivariate logistic regression models. RESULTS: The ratio of apoB/apoA-1, TC/HDL-C, LDL-C/HDL-C, and Non-HDL-C/HDL-C were correlated with Gensini scores. Area under the ROC curves for predicting high Gensini scores in the ratios of apoB/apoA-1, TC/HDL-C, LDL-C/HDL-C and Non-HDL-C/HDL-C were 0.62, 0.60, 0.59 and 0.60, respectively (P < 0.005 for all). According to multivariate logistic regression analysis after adjusted with demographic characteristic and other lipid parameters, the ratio of apoB/apoA-1 is qualified as an independent discriminator for the severity of CAD. However, after further adjusting different baseline variables, such as left ventricular ejective fraction, hemoglobin A1c, leukocytes count and serum creatinine, none of the above lipid ratios remained. CONCLUSIONS: Compared with other lipid parameters, the ratio of apoB/apoA-1 appears to be more significantly correlated with the extent of coronary artery lesions in Chinese diabetics, but it was not an independent predictor in these settings.

Dietary exposure to endocrine disrupting chemicals in metropolitan population from China: a risk assessment based on probabilistic approach.

The intake of contaminated foods is an important exposure pathway for endocrine disrupting chemicals (EDCs). However, data on the occurrence of EDCs in foodstuffs are sporadic and the resultant risk of co-exposure is rarely concerned. In this study, 450 food samples representing 7 food categories (mainly raw and fresh food), collected from three geographic cities in China, were analyzed for eight EDCs using high performance liquid chromatography tandem mass spectrometry (HPLC-MS/MS). Besides estrone (E1), other EDCs including diethylstilbestrol (DES), nonylphenol (NP), bisphenol A (BPA), octylphenol (OP), 17ß-estradiol (E2), 17α-ethinylestradiol (EE2), and estriol (E3) were ubiquitous in food. Dose-dependent relationships were found between NP and EE2 (r=0.196, p<0.05), BPA (r=0.391, p<0.05). Moreover, there existed a correspondencebetween EDCs congener and food category. Based on the obtained database of EDCs concentration combined with local food consumption, dietary EDCs exposure was estimated using the Monte Carlo Risk Assessment (MCRA) system. The 50th and 95th percentile exposure of any EDCs isomer were far below the tolerable daily intake (TDI) value identically. However, the sum of 17ß-estradiol equivalents (∑EEQs) exposure in population was considerably larger than the value of exposure to E2, which implied the underlying resultant risk of multiple EDCs in food should be concern. In conclusion, co-exposure via food consumption should be considered rather than individual EDCs during health risk evaluation.

Toxic metals in children's toys and jewelry: coupling bioaccessibility with risk assessment.

A total of 45 children's toys and jewelry were tested for total and bioaccessible metal concentrations. Total As, Cd, Sb, Cr, Ni, and Pb concentrations were 0.22-19, 0.01-139, 0.1-189, 0.06-846, 0.14-2894 and 0.08-860,000 mg kg(-1). Metallic products had the highest concentrations, with 3-7 out of 13 samples exceeding the European Union safety limit for Cd, Pb, Cr, or Ni. However, assessment based on hazard index >1 and bioaccessible metal showed different trends. Under saliva mobilization or gastric ingestion, 11 out of 45 samples showed HI >1 for As, Cd, Sb, Cr, or Ni. Pb with the highest total concentration showed HI <1 for all samples while Ni showed the most hazard with HI up to 113. Our data suggest the importance of using bioaccessibility to evaluate health hazard of metals in children's toys and jewelry, and besides Pb and Cd, As, Ni, Cr, and Sb in children's products also deserve attention.

Quantitative multiparametric MRI assessment of glioma response to radiotherapy in a rat model.

BACKGROUND: The inability of structural MRI to accurately measure tumor response to therapy complicates care management for patients with gliomas. The purpose of this study was to assess the potential of several noninvasive functional and molecular MRI biomarkers for the assessment of glioma response to radiotherapy. METHODS: Fourteen U87 tumor-bearing rats were irradiated using a small-animal radiation research platform (40 or 20 Gy), and 6 rats were used as controls. MRI was performed on a 4.7 T animal scanner, preradiation treatment, as well as at 3, 6, 9, and 14 days postradiation. Image features of the tumors, as well as tumor volumes and animal survival, were quantitatively compared. RESULTS: Structural MRI showed that all irradiated tumors still grew in size during the initial days postradiation. The apparent diffusion coefficient (ADC) values of tumors increased significantly postradiation (40 and 20 Gy), except at day 3 postradiation, compared with preradiation. The tumor blood flow decreased significantly postradiation (40 and 20 Gy), but the relative blood flow (tumor vs contralateral) did not show a significant change at most time points postradiation. The amide proton transfer weighted (APTw) signals of the tumor decreased significantly at all time points postradiation (40 Gy), and also at day 9 postradiation (20 Gy). The blood flow and APTw maps demonstrated tumor features that were similar to those seen on gadolinium-enhanced T1-weighted images. CONCLUSIONS: Tumor ADC, blood flow, and APTw were all useful imaging biomarkers by which to predict glioma response to radiotherapy. The APTw signal was most promising for early response assessment in this model.

Healthcare Resource Utilization and Costs Associated with Autosomal Dominant Polycystic Kidney Disease.

Background: Autosomal dominant polycystic kidney disease (ADPKD), a hereditary nephropathy, eventually leads to end-stage renal disease (ESRD), typically by mid-life. Objectives: The objective of this study was to assess real-world healthcare resource utilization and cost among commercially insured (COM) and Medicare Advantage (MAPD) ADPKD patients in addition to the cost profile by chronic kidney disease (CKD) stage. Methods: Patients diagnosed with ADPKD (two or more claims) with ≥30 days of continuous medical and pharmacy benefits and no evidence of autosomal recessive polycystic kidney disease were selected (Optum Research Database and Impact National Benchmarking Database: 1/1/06-8/31/12). Plan and patient paid healthcare costs and resource utilization per patient per month (PPPM) were described in total and by insurance type. CKD stage was established based on serum creatinine laboratory values or dialysis-related codes. Adjusted, CKD stage-specific costs were predicted for 4 years using regression models. Results: Of the 36,253,096 patients in the databases (1/1/06-8/31/12), 5,051 had evidence of ADPKD. Following exclusion criteria, 4,356 COM and 468 MAPD ADPKD patients remained. Total healthcare resource utilization and costs were high, and costs increased substantially from CKD stage 1-5. PPPM healthcare costs were 37% for ADPKD management and 52% for dialysis services. Predicted 4-year healthcare costs by CKD stage were $40,164 (stage 1), $33,397 (stage 2), $42,686 (stage 3), $148,402 (stage 4), and $207,548 (stage 5). Conclusions: Healthcare resource utilization and costs associated with ADPKD were substantial, irrespective of payer type, and primarily driven by CKD stage. Of the total healthcare costs, 88% were ADPKD- and dialysis-related. Most impactful was the spike in predicted cost when patients progressed from CKD stage 3 to stage 4 (by 348%) after multivariate adjustment. These stage 4-associated costs are primarily due to ultimate progression into stage 5 and ESRD within the 4-year time frame.