Automatic Reporting of Estimated Glomerular Filtration Rate—Jumping the Gun?

Abstract

In 2002, the Kidney Disease Outcomes Quality Initiative recommended the use of an estimated glomerular filtration rate (eGFR) to detect early kidney disease (1). Subsequently, the National Kidney Disease Education Program (NKDEP) has taken the lead in promoting the use of eGFR. In their recommendations to health professionals (2), the NKDEP suggested determining an eGFR, as well as measuring a spot urine albumin/creatinine ratio, in patients at high risk for kidney disease, i.e., those with diabetes, hypertension, or a family history of kidney disease. The NKDEP defines chronic kidney disease (CKD) as a GFR persistently 30 mg/g creatinine. For calculating eGFR in adults, the NKDEP recommends using either of 2 versions of the 4-variable Modification of Diet in Renal Disease (MDRD) Study equation. In their Suggestions for Laboratories , the NKDEP “strongly encourages clinical laboratories to automatically report eGFR when serum creatinine is reported” (3). Beginning in late 2003, members of various kidney societies were asked to strongly encourage their local laboratories to report an eGFR with each creatinine result. Recently, this encouragement has extended to the proposal in several states of laws requiring the reporting of eGFR with every creatinine result (4). Laboratorians (and legislatures) should consider several reservations before adopting automatic reporting of eGFR. Most creatinine measurements are not made to assess renal function in persons who have CKD or are at high risk for CKD. The great majority of creatinine measurements are ordered as part of a Basic Metabolic Panel. The Basic Metabolic Panel is used for assessment and monitoring of hundreds of conditions, many unrelated to renal function. The most common indication in most hospital laboratories is for routine monitoring of inpatients. The recommendation to report an eGFR with every creatinine measurement becomes, in effect, a …