Automated laboratory reporting of estimated glomerular filtration rate: Is it good for the health of patients and their doctors?

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 accuracy 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 prescription of renally excreted medications.