Economic Evaluation in Kidney Transplantation

ABSTRACT Objective: To identify gaps in the economic literature as it pertains to kidney transplantation in order to inform future research topics as well as to identify the most cost-effective national screening policy for high-infectious risk organ donors and the most cost-effective utilization of marginal quality donated kidneys. Methods: A scoping review was employed to review the economics and kidney transplantation literature in order to perform a research gaps analysis. A decision tree analysis was used to elucidate the most cost-effective high-infectious risk donor screening strategy and a Markov model was utilized to determine patient phenotypes that would benefit from marginal quality kidney donor organs as well as the costeffectiveness of accepting certain quality organs for specific patient phenotypes. Results: The scoping review identified 278 articles from 102 medical and economic journals with research gaps including patient-perspective, pediatrics, and structural/macroeconomic topics. The decision tree analysis found that Selected NAT with ELISA screening strategy was the most cost-effective with an $18,100 savings per QALY compared to the current screening practice (discarding the ELISA Only strategy as a strategy that would not be employed in real practice) . The Markov model identified a large number of patient phenotypes that benefited from high KDPI organ acceptance with increased survival and QALYs and decreased lifetime treatment costs. Conclusion: Evaluation of the literature related to economics in kidney transplantation afforded the opportunity to address directed research by identifying future research efforts based on formal gaps analysis. The scarcity of organs in transplantation offered a rich opportunity to explore the related economic concepts of individual welfare maximization, allocation efficiency, and cost-effective analysis of competing screening strategies. The results of this dissertation may have policy impacts regarding the funding of associated research and use of marginal quality donated kidneys for transplantation

Clinical Studies, Big Data, and Artificial Intelligence in Nephrology and Transplantation

In recent years, artificial intelligence has increasingly been playing an essential role in diverse areas in medicine, assisting clinicians in patient management. In nephrology and transplantation, artificial intelligence can be utilized to enhance clinical care, such as through hemodialysis prescriptions and the follow-up of kidney transplant patients. Furthermore, there are rapidly expanding applications and validations of comprehensive, computerized medical records and related databases, including national registries, health insurance, and drug prescriptions. For this Special Issue, we made a call to action to stimulate researchers and clinicians to submit their invaluable works and present, here, a collection of articles covering original clinical research (single- or multi-center), database studies from registries, meta-analyses, and artificial intelligence research in nephrology including acute kidney injury, electrolytes and acid–base, chronic kidney disease, glomerular disease, dialysis, and transplantation that will provide additional knowledge and skills in the field of nephrology and transplantation toward improving patient outcomes

Smoking and Second Hand Smoking in Adolescents with Chronic Kidney Disease: A Report from the Chronic Kidney Disease in Children (CKiD) Cohort Study

The goal of this study was to determine the prevalence of smoking and second hand smoking [SHS] in adolescents with CKD and their relationship to baseline parameters at enrollment in the CKiD, observational cohort study of 600 children (aged 1-16 yrs) with Schwartz estimated GFR of 30-90 ml/min/1.73m2. 239 adolescents had self-report survey data on smoking and SHS exposure: 21 [9%] subjects had “ever” smoked a cigarette. Among them, 4 were current and 17 were former smokers. Hypertension was more prevalent in those that had “ever” smoked a cigarette (42%) compared to non-smokers (9%), p\u3c0.01. Among 218 non-smokers, 130 (59%) were male, 142 (65%) were Caucasian; 60 (28%) reported SHS exposure compared to 158 (72%) with no exposure. Non-smoker adolescents with SHS exposure were compared to those without SHS exposure. There was no racial, age, or gender differences between both groups. Baseline creatinine, diastolic hypertension, C reactive protein, lipid profile, GFR and hemoglobin were not statistically different. Significantly higher protein to creatinine ratio (0.90 vs. 0.53, p\u3c0.01) was observed in those exposed to SHS compared to those not exposed. Exposed adolescents were heavier than non-exposed adolescents (85th percentile vs. 55th percentile for BMI, p\u3c 0.01). Uncontrolled casual systolic hypertension was twice as prevalent among those exposed to SHS (16%) compared to those not exposed to SHS (7%), though the difference was not statistically significant (p= 0.07). Adjusted multivariate regression analysis [OR (95% CI)] showed that increased protein to creatinine ratio [1.34 (1.03, 1.75)] and higher BMI [1.14 (1.02, 1.29)] were independently associated with exposure to SHS among non-smoker adolescents. These results reveal that among adolescents with CKD, cigarette use is low and SHS is highly prevalent. The association of smoking with hypertension and SHS with increased proteinuria suggests a possible role of these factors in CKD progression and cardiovascular outcomes