Biochemia Medica, Vol. 17 No. 1, 2007.
Review article
Automated laboratory reporting of estimated glomerular filtration rate: is it good for the health of patients and their doctors?
Euan Noble
David W. Johnson
Abstract
Serum creatinine concentration is an unreliable and insensitive marker of chronic kidney disease (CKD). To improve CKD detection, many European and North American laboratories and all Australasian laboratories calculate and report an estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease (MDRD) formula with every request for serum creatinine concentration. The aim of this paper is to provide timely information to Clinical Chemists about the strengths, weaknesses and available evidence for the role of automated laboratory reporting of eGFR in CKD detection. The accu-racy and precision of eGFRs is reasonable in most adults in whom calculated values are < 60 mL/min/1.73 m2. However, eGFRs should be interpreted with caution in some settings, (particularly patients with eGFRs > 60 mL/min/1.73 m2 and children). This paper also discusses eGFR-related decision points for clinical actions, the indications for nephrologist referral, the importance of creatinine assay standardisation and the role of eGFR in drug dose decision-making. In conclusion, automatic laboratory reporting of eGFR will enhance early detection of CKD, allow the timely institution of appropriate reno- and cardioprotective therapies, and better inform decisions regarding the pres-cription of renally excreted medications.
Keywords
chronic kidney disease; Cockcroft-Gault equation, glomerular filtration rate; glomerular filtration rate estimating equations; modification of diet in renal disease equation; serum creatinine
Hrčak ID:
12857
URI
Publication date:
7.6.2007.
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