Screening for acquired cystic kidney disease: a decision analytic perspective

Area of Science:

• Nephrology
• Oncology
• Medical Imaging

Background:

• Acquired cystic kidney disease (ACKD) is linked to increased renal malignancy risk in dialysis patients.
• Current recommendations for screening ACKD and renal tumors lack defined target populations, strategies, benefits, and risks.

Purpose of the Study:

• To evaluate the benefits and risks of different screening strategies for ACKD and renal tumors in dialysis patients.
• To determine the optimal screening approach based on patient life expectancy and potential gains in survival.

Main Methods:

• Decision analysis was employed to model screening strategies.
• Strategies included periodic computed tomography (CT) or ultrasound for all dialysis patients, with annual screening for those with cysts.
• These were compared to a strategy of opportunistic screening based on clinical suspicion.

Main Results:

• Screening with CT or ultrasound could potentially halve cancer deaths in patients with a 25-year life expectancy.
• ACDK screening may offer up to a 1.6-year gain in life expectancy for select patients.
• For most patients starting renal replacement therapy, gains in life expectancy are minimal (days) due to age and comorbidities.

Conclusions:

• Routine ACKD screening is not justified for the entire end-stage renal disease (ESRD) population due to limited life expectancy gains.
• Screening may benefit younger, healthier patients, but the magnitude of benefit requires further definition.
• The analysis was biased towards screening strategies, indicating uncertainty in benefit magnitude.