Automatic Reporting of Estimated Glomerular Filtration Rate—Just What the Doctor Ordered

Abstract

Chronic kidney disease (CKD) is a recently recognized public health problem. CKD is defined as the presence of markers of kidney damage or of glomerular filtration rate (GFR) <60 mL · min−1 · (1.73 m−2) [<1 mLs−1 · (1.73 m−2)−1] for three months or more (1)(2)(3). According to these definitions, the prevalence of CKD in noninstitutionalized US adults is estimated as ∼11%, or ∼20 million people (4). CKD is associated with poor outcomes and high cost, disproportionately affecting the elderly and racial and ethnic minorities. Thus, new public health campaigns focus on early detection of CKD, especially in patients at increased risk, including those with hypertension, diabetes, cardiovascular disease, or a family history of CKD (5). To facilitate early detection of CKD, many national and international organizations now recommend automatic reporting of estimated glomerular filtration rate (eGFR) whenever serum creatinine is measured (1)(2)(3)(5)(6)(7)(8)(9)(10)(11)(12). Approximately 20% of participants in the College of American Pathologists’ chemistry survey were reporting eGFR calculations in 2005 (13). In this issue of Clinical Chemistry , Dr. Rainey offers a dissenting view, likening automatic eGFR reporting to “jumping the gun”. A careful examination of the arguments reveals, in our view, that reporting eGFR whenever a serum creatinine is requested is “just what the doctor ordered”. Dr. Rainey asserts that “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 serum creatinine level holds no clinically useful meaning other than to serve as an index of kidney function. …