GFR estimates are improved by use of cystatin C and creatinine. Has anyone reviewed the net impact on a health system of adding cystatin C (ubiquitously when eGFR requested, or selectively when eGFR based on creatinine is inconclusive) in terms of:
Patient outcomes eg Change in:
- End stage renal disease rates
- overall health outcomes (eg mortality)
Sustainability outcomes eg Change in:
- End stage renal disease rates
- patient outpatient visits (CKD, Heart failure)
- patient inpatient days (acute, intensive care for AKI, CKD, Acute coronary syndrome, Heart failure)
- patient investigations (total number of cystatin C, creatinine, and every other test ordered on the same set of bloodwork)
- patient medications (if this could be monitored)
This would be best analyzed in a health region specific manner ie 2 comparable regions which have already, and have not yet, implemented cystatin C routinely.
The idea is that a benefit in the patient outcomes would justify the routine use of cystatin C (for patient care and sustainability reasons) but a failure to effect outcomes, may result in new sustainability concerns due to increased lab testing, increased patient referrals, and increased therapies.
Thank you
It's something I've considered, but don't have the answer to.
Same could be said for integrating KFRE into IT.
Both have potential to improve accuracy on identifying progressive CKD and most appropriate patients to be referred to secondary care / have interventions optimised, therefore have potential to delay ESKD.
BUT, both also have risk of increased investigation/testing if not used optimally as you say.
We (colleagues in Glasgow) started looking at how to gather data to inform this question, but because care pathways are complex , and longterm outcome data would be required (or modelled), we've stalled a bit.
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