Outcome Comparisons Between Patients on Peritoneal Dialysis With and Without Polycystic Kidney Disease: A Nationwide Matched Cohort Study.

Polycystic kidney disease (PCKD) is the most common hereditary cause of end-stage renal disease. The complications associated with this disease may affect the performance of peritoneal dialysis (PD). The aim of this study was to compare the outcomes between patients on PD with PCKD and without PCKD.We extracted an incident cohort of adult (≥ 20 years old) patients on long-term PD from the Taiwan National Health Insurance Research Database. Patients with PCKD were identified by specific diagnosis codes. We recorded baseline comorbidities, socioeconomic status, timing of referral to a nephrologist, prior hemodialysis history before PD, and the type of PD modalities. We compared the risk of death, technique failure, peritonitis, hospitalization, and outpatient visiting as well as overall medical expenditure between the patients with PCKD and a groups of patients without PCKD who were propensity-score matched (1:3). The analysis was carried out by various Cox regression models that considered competing risk and time-varying coefficients. We enrolled 139 patients with PCKD and 7739 patients without PCKD who started long-term PD between 1999 and 2010. Patients with PCKD were less comorbid and more often treated with automated PD. In the propensity-score matched analysis, both overall survival and technique survival did not differ between the patients and the result was similar for hospitalization and peritonitis after adjusting for the application of automated PD. Furthermore, the overall annual medical expenditures were similar between the patients with and without PCKD. PD patients with PCKD are comparable to PD patients without PCKD in terms of risk of death, peritonitis, technique failure, and hospitalization in the present study. Furthermore, the medical expenses of the 2 groups after initiation of PD are also indistinguishable.

Renal function and healthcare costs in patients with polycystic kidney disease.

BACKGROUND AND OBJECTIVES: Characterizing relationships of kidney function to healthcare costs in polycystic kidney disease has applications for economic evaluations of standard and emerging therapies. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The administrative records (2003 to 2006) of a private health insurer were examined to identify polycystic kidney disease patients (n = 1913) from ICD9 diagnosis codes on billing claims. The first available diagnostic claim was assumed as an index date, and baseline estimated GFR (eGFR) was computed using closest serum creatinine value. The associations of eGFR with annualized charges were modeled by nonlinear and linear regression. RESULTS: Medical, pharmacy, and total healthcare costs varied significantly by baseline kidney function, such that mean total annualized charges (unadjusted) were approximately 5-fold higher in patients with eGFR < 15 ml/min compared with those with eGFR >or= 90 ml/min. After adjustment for age and gender, total charges did not differ significantly among patients with eGFR > 30 ml/min, and but rose precipitously with eGFR < 30 ml/min. Each ml/min decline <30 ml/min predicted approximately $5435 higher adjusted annual charges. Results were similar after adjustment for baseline diabetes and cardiovascular disease as identified in claims, while significantly higher adjusted charges were detected with eGFR = 31 to 60 ml/min versus >or=90 ml/min in a subgroup free of diabetes and cardiovascular disease. CONCLUSIONS: Healthcare charges are associated with advanced renal dysfunction in polycystic kidney disease patients. Strategies that prevent loss of renal function below 30 ml/min have the potential to generate substantial reductions in medical charges.

Insurability of children with congenital urological anomalies.

PURPOSE: We sought to determine life insurance underwriting practices for children diagnosed with multicystic dysplastic kidney or unilateral neonatal hydronephrosis, and evaluate whether management options (observation versus operative intervention) have an influence on such practices. MATERIALS AND METHODS: A questionnaire and history of 1 child with multicystic dysplastic kidney and 1 with unilateral neonatal hydronephrosis were distributed to 348 insurance companies licensed to issue life insurance policies in New Jersey. The medical director of each insurance company was requested to indicate the current underwriting practices for life insurance policies based on these 2 case scenarios, and asked whether observation or operative intervention influenced such decisions. RESULTS: Of the 348 insurance companies licensed to issue life insurance 130 (37.4%) responded, including 5 (3.8%) that did not choose to participate in the study, 56 (43.1%) that did not issue life insurance to children and 69 (53.1%) that completed the questionnaire based on current life insurance underwriting practices. For a child with multicystic dysplastic kidney 10 companies (14.5%) would issue life insurance if treatment involved observation only, while 49 (71%) would do so after nephrectomy. For a child with unilateral neonatal hydronephrosis 19 (27.5%) companies would issue life insurance if treatment involved observation only, while 46 (66.7%) would do so after pyeloplasty. CONCLUSIONS: Despite limited long-term data on and uncertainty about the natural course of multicystic dysplastic kidney and unilateral neonatal hydronephrosis, treatment options offered a child with a congenital urological anomaly may have a significant impact on the ability to obtain life insurance. Children with multicystic dysplastic kidney and unilateral neonatal hydronephrosis can usually obtain life insurance after early operative intervention (nephrectomy and pyeloplasty, respectively), although sometimes at higher cost.