Dear all,
Feedback to the question:
"Should urea be dropped from the U&E profile and replaced with a Renal
Profile consisting of sodium, potassium, creatinine and eGFR?"
The comments ranged from an emphatic "No" to "[we have been doing this on out-patients and GP patients] since 1994"
There was no consensus. Several still found urea useful in assessing pre-renal uraemia and hydration. Others clearly thought that it had no use as a general test in primary care.
My interpretation of feedback:
1. There may be some merit in dropping urea from routine primary care U&E requests but the money saved would be relatively small.
2. I have sympathy for the thoughts of person 6 in the feedback below. Presumably in the USA this has all been sorted with centrally defined profiles.
3. I'm glad I didn't ask about the merits of ALT, AST and gamma GT in a liver profile.
Regards
Martin
Feedback from Mailbase:
1. Urea is very useful for identifying dehydration when creatinine may not
be raised.
2. We tried to drop ureas about 20 years ago in XXXX but there all
the cases that needed urea: ITU, A&E, patients > 75 yrs, babies etc etc
Too difficult in sample reception then. But now with EPR and order comms (for the lucky ones) it should be easy
to drop most ureas.
3. No!
4. We did this for primary care a year or more ago, but have been
unable to convince our secondary care colleagues to do likewise.
5. We only do urea on in-patients. This has been the case since 1994. I dropped it from the out-patient & GP work at that time. It remains available on request, but these are very few. We have been reporting eGFR since April, so in effect we are in line with your proposals apart from in-patient work.
6. There is too much local choice on what should be included in a profile. There is a requirement to have national definitions. This would be based on best evidence, will unify practice across the country and will give clarity for future tariffs and reimbursements.
7. Current practice in XXXXX:
Primary care: Plasma sodium, potassium, creatinine, eGFR (18 y and
over).
Secondary and tertiary care: Plasma sodium, potassium, creatinine.
Summary of current UK practice is in one of the Keele benchmarking
reports.
8. We did this years ago for GPs,tho' have persisted in including urea for hosp
requests,couldn't persuade hosp users to drop it at the time,tho' might be
worth another go,partic now we have eGFR.
9. Sounds more logical
10. and you pick up pre-renal uraemia how? eGFR is irrelevant in the elderly
hospital in-patients who of course will have low creats due to low
muscle mass. is it worth the grief? 4 part renal profile: Na+, K+, Urea,
creat. Diminiution of info is not a service.
11. Personal view: urea gives me valuable information about hydration
Status. For example in a 65 year old patient with a history of vomiting:
Na 145 K 5.0 urea 20.1 creatinine 140 suggests dehydration and may be GI
bleed.
Na 145 K 5.0 urea 5.5 creatinine 140 suggests normal hydration and some
renal impairment.
As DB and on ward rounds including ICU I find urea in the 'U/E' very
helpful. It is a useful adjunct to creatinine and/or eGFR giving
different information and should not be dropped in my view..
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