关键词: 早期糖尿病肾病, 尿蛋白筛查, 筛查频率, 卫生经济学

Abstract: Objective To compare the clinical efficacy and health economic outcomes of different urinary protein screening frequencies in patients with early-stage diabetic kidney disease (DKD). Methods Based on electronic medical records of patients with early-stage DKD at Peking University Third Hospital from 2023 to 2024, this study stratified patients by screening frequency into a standard screening group (biannually) and a low-frequency screening group (annually). Cox regression analysis was employed to assess the risk of disease progression, while a generalized linear model was utilized to analyze medical costs. The incremental cost-effectiveness ratio (ICER) was subsequently calculated. Results A total of 206 patients were included in each group. The disease progression rate was significantly lower, and the progression-free survival time was significantly longer in the standard screening group compared to the low-frequency screening group (P<0.05). After adjusting for confounding factors using a Cox proportional hazards model, the risk of disease progression remained significantly lower in the standard screening group (HR=1.768, 95% CI: 1.136-2.751, P=0.012). Various medical expenditures and the cumulative direct medical costs were higher in the standard screening group (P<0.05). Following adjustment with a generalized linear model, standard screening was identified as an independent predictor of increased per capita cumulative direct medical costs (OR=1.332, 95% CI: 1.320-1.345, P<0.001). The ICER estimation indicated that for each additional percentage point reduction in progression risk, an extra medical cost of approximately 988 RMB was incurred. The total incidence of the composite renal endpoint was significantly lower in the standard screening group, whereas overall screening compliance, glycemic control rates, and blood pressure control rates were significantly higher (P<0.05). Conclusion Among patients with early-stage DKD, regular biannual urinary protein screening, despite elevating short-term direct medical costs, significantly reduces the risk of disease progression, delays its rate, diminishes the incidence of composite renal endpoints, and contributes to the enhancement of glycemic and blood pressure control.

Key words: Early-stage diabetic kidney disease, Urinary protein screening, Screening frequency, Health economics