Uremia (End-Stage Renal Disease): How Cost-Effective are Preventive Strategies?

Many strategies have been shown to be cost-effective for prevention of end-stage renal disease (ESRD), most often by Markov modeling using assumptions based on randomized clinical trails and observational studies. Targeted screening for proteinuria in diabetics and in hypertensive patients is cost-effective for prevention of ESRD, but such screening is not cost-effective when applied to the general population. Screening for chronic kidney disease based on estimated glomerular filtration rate alone is not recommended. Perhaps, treatment of all newly diagnosed type 2 diabetics with an inhibitor of angiotensin-II without screening for proteinuria will also prevent or delay ESRD in a cost-effective manner. Intensive interventions and the use of angiotensin-II inhibition in incipient and overt nephropathy in type 1 and type 2 diabetes is also cost-effective in preventing ESRD. Rigorous control of blood pressure to desired targets also lowers the risks of ESRD in both diabetic and nondiabetic nephropathies, most likely in a cost-effective manner. Newer strategies involving statins and new combinations of agents are emerging but have not yet been tested for their cost-effectiveness in preventing ESRD cost-effectiveness.