肾脏诊断对糖尿病肾病中医生决策的影响。

A kidney diagnostic's impact on physician decision-making in diabetic kidney disease.

机构信息

Boston Healthcare Associates, 33 Arch St, 17th Floor, Boston, MA 02110. Email:

出版信息

Am J Manag Care. 2022 Dec;28(12):654-661. doi: 10.37765/ajmc.2022.89207.

DOI:10.37765/ajmc.2022.89207

PMID:36525658

Abstract

OBJECTIVES

Estimated glomerular filtration rate (eGFR) and albuminuria, the current standard-of-care tests that predict risk of kidney function decline in early-stage diabetic kidney disease (DKD), are only modestly useful. We evaluated the decision-making impact of an artificial intelligence-enabled prognostic test, KidneyIntelX, in the management of DKD by primary care physicians (PCPs).

STUDY DESIGN

This was a prospective web-based survey administered among PCPs in the United States.

METHODS

We used conjoint analysis with multivariable logit models to estimate PCP preferences. The survey included hypothetical patient profiles with 6 attributes: albuminuria, eGFR, age, blood pressure (BP), hemoglobin A1c (HbA1c), and KidneyIntelX result. Each PCP viewed 8 patient profiles randomly selected from 42 unique profiles having 1 level from each attribute. For each patient, PCPs were asked to indicate whether they would prescribe a sodium-glucose cotransporter-2 (SGLT2) inhibitor, increase angiotensin receptor blocker (ARB) dose, and/or refer to a nephrologist.

RESULTS

A total of 401 PCPs completed the survey (response rate, 8.8%). The relative importance of the top 2 attributes for each decision were HbA1c (52%) and KidneyIntelX result (23%) for prescribing SGLT2 inhibitors, BP (62%) and KidneyIntelX result (13%) for increasing ARB dose, and eGFR (42%) and KidneyIntelX result (27%) for nephrologist referral. A high-risk KidneyIntelX result was associated with significantly higher odds of PCPs prescribing SGLT2 inhibitors (odds ratio [OR], 1.64; 95% CI, 1.29-2.08), increasing ARB dose (OR, 1.49; 95% CI, 1.17-1.89), and referring to a nephrologist (OR, 2.47; 95% CI, 1.99-3.08) compared with no test.

CONCLUSIONS

The KidneyIntelX test had greater relative importance than albuminuria and eGFR to PCPs in making treatment decisions and was second only to eGFR for nephrologist referrals. Because of its significant impact on decision-making, KidneyIntelX has high clinical utility in DKD management.

摘要

目的

估算肾小球滤过率（eGFR）和白蛋白尿是预测早期糖尿病肾病（DKD）肾功能下降风险的现行标准护理检测方法，但它们的作用有限。我们评估了人工智能支持的预后检测工具 KidneyIntelX 在初级保健医生（PCP）管理 DKD 方面的决策影响。

研究设计

这是一项在美国进行的基于网络的前瞻性调查。

方法

我们使用联合分析和多变量逻辑模型来评估 PCP 的偏好。该调查包括 6 个属性的假设患者特征：白蛋白尿、eGFR、年龄、血压（BP）、血红蛋白 A1c（HbA1c）和 KidneyIntelX 结果。每位 PCP 随机查看 8 个从 42 个具有每个属性 1 个水平的独特特征中随机选择的患者特征。对于每个患者，PCP 被要求表明他们是否会开钠-葡萄糖协同转运蛋白 2（SGLT2）抑制剂、增加血管紧张素受体阻滞剂（ARB）剂量以及/或者转介给肾病医生。

结果

共有 401 名 PCP 完成了调查（回复率为 8.8%）。对于每个决策，前 2 个最重要的属性分别是 HbA1c（52%）和 KidneyIntelX 结果（23%），用于开 SGLT2 抑制剂；BP（62%）和 KidneyIntelX 结果（13%），用于增加 ARB 剂量；eGFR（42%）和 KidneyIntelX 结果（27%），用于肾病医生转诊。高风险的 KidneyIntelX 结果与 PCP 开 SGLT2 抑制剂（比值比 [OR]，1.64；95%置信区间 [CI]，1.29-2.08）、增加 ARB 剂量（OR，1.49；95% CI，1.17-1.89）和转介给肾病医生（OR，2.47；95% CI，1.99-3.08）的可能性显著增加相比，没有检测。