03 Mar Many Diagnostic Tests For Chronic Kidney Disease Have Low Diagnostic Yield
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Mendu: Chronic kidney disease affects a significant number of adults in the United States, approximately 13%, and is associated with significant morbidity, mortality and cost. We conducted a review of 1487 patients referred for initial evaluation of chronic kidney disease to two academic medical centers in Boston over a 3-year period, and examined how often laboratory and imaging tests were ordered and how often these tests affected diagnosis and/or management. The main finding was that a number of tests (renal ultrasound, paraprotein testing, serologic testing) were commonly ordered despite low diagnostic and management yield. Urine quantification and hemoglobin A1c testing had the highest diagnostic and management yield.
MedicalResearch: What should clinicians and patients take away from your report?
Dr. Mendu: Our study suggests that reflexively ordering a multitude of tests to evaluate chronic kidney disease is likely not the best approach with respect to care for patients and associated costs. An evidence-based targeted approach to evaluating chronic kidney disease is likely more efficient and would reduce costs.
MedicalResearch: What recommendations do you have for future research as a result of this study?
Dr. Mendu: We plan on conducting and publishing further research to elucidate when certain tests should be ordered based on pretest probabilities of diagnostic and management yield.
Upcoming JAMA March 2, 2015 at 11am EST.
Mallika L. Mendu, Andrew Lundquist, Ayal A. Aizer, David E. Leaf, Emily Robinson, David J. R. Steele, Sushrut S. Waikar. The Usefulness of Diagnostic Testing in the Initial Evaluation of Chronic Kidney Disease. JAMA Internal Medicine, 2015; DOI: 10.1001/jamainternmed.2015.17
MedicalResearch.com Interview with: Mallika L. Mendu, MD, MBA (2015). Many Diagnostic Tests For Chronic Kidney Disease Have Low Diagnostic Yield