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

¹ Division of Nephrology, Department of Medicine, Tufts-New England Medical Center, Boston, MA.
² Renal Division, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY.

^aAddress correspondence to this author at: Lesley A Stevens, Division of Nephrology, Tufts-New England Medical Center, 750 Washington St, Box 391, Boston, MA 02111. Fax 617-636-5740; e-mail Lstevens1@Tufts-nemc.org.

The first 300 words of the full text of this article appear below.

	Introduction

 
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".

	the only reason to measure serum creatinine is to assess gfr

 
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 . . . [Full Text of this Article]

	gfr estimating equations provide more accurate estimates of gfr than does serum creatinine alone

 

	limitations of gfr estimates primarily reflect limitations of serum creatinine as an endogenous filtration marker

 
Variation in creatinine assays.
Determinants of serum creatinine other than GFR.
Generalizing an estimating equation developed in a population with CKD to populations without CKD.
Rapidly changing kidney function.

	in some circumstances, creatinine clearance measurements can be used as confirmatory tests

 

	early detection and appropriate evaluation and management of ckd can improve outcomes

 

	reporting Egfr simplifies the evaluation and management of ckd

 

	the benefit of reporting Egfr likely outweighs the harm

 

	education vs legislation

 

The following articles in journals at HighWire Press have cited this article:

				M. L. Melamed, C. Bauer, and T. H. Hostetter eGFR: Is It Ready for Early Identification of CKD? Clin. J. Am. Soc. Nephrol., September 1, 2008; 3(5): 1569 - 1572. [Abstract] [Full Text] [PDF]

				B. R. Herts, E. Schneider, E. D. Poggio, N. A. Obuchowski, and M. E. Baker Identifying Outpatients with Renal Insufficiency before Contrast-enhanced CT by Using Estimated Glomerular Filtration Rates versus Serum Creatinine Levels Radiology, July 1, 2008; 248(1): 106 - 113. [Abstract] [Full Text] [PDF]