And if you have been "focussed" on making sure that profiles are not too broad for a long time you don't have option of replacing one test with another.
Q - is this an alternative approach [if it's any good I'm claiming the credit!]
Aside from e.g. chemo dosing, do we need ultra-accurate creatinine?
I'm on an ACEI, my creat is solidly consistent, therefore my eGFR should also be [apart from age change]. We are all aware of UoM for eGFR calculation [my muscular frame vs same weight obese patient etc], so ...........
What proportion of primary care creatinines are like mine? If eGFR is say greater than 70, does it matter which creatinine we use as eGFR will not be less than 60?
If eGFR is <70, should we auto request [ie get computer to sort this] an enzymatic creatinine to calibrate "enzymatic eGFR" against eGFR produced by jaffe, unless there has been an "enzymatic eGFR" within past ?12 months??
Would that dramatically reduce enzymatic creatinine spend without compromising patient care??
Yes it would be nice if IVD reduced cost of assay to pence, but until they do, remember there is no such thing as a free lunch, "included within MSC" means you are paying for it somewhere!
dj
-----Original Message-----
From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of COLLINS MICHAEL (RM1) Norfolk and Norwich University Hospital
Sent: 17 February 2014 12:34
To: [log in to unmask]
Subject: Re: I'm confused......
We moved to enzymatic creatinine some years ago and the results are excellent. We paid for this by removing the even more expensive bicarbonate from U&E except as a reflex test. Note that the even more expensive bicarbonate is also an enzymatic test.
I'm sure the manufacturers are charging what the market will bear but I don't think your question is fair.
Why is sodium chloride so cheap when uranium hexafluoride is so expensive. After all they are both chemicals.
Mike Collins
BMS3
Biochemistry Automation
Norfolk & Norwich University Hospital
England
[log in to unmask]
http://www.nnuh.nhs.uk/
-----Original Message-----
From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Richard Jones [Pathology]
Sent: 17 February 2014 11:15
To: [log in to unmask]
Subject: I'm confused......
I've been involved in a lot of discussion recently on AKI and CKD and we keep coming round to agreeing that creatinine's are terrible and all would be well (or at least better ) if we used enzymic tests. The eGFR fiasco taught is that if nothing else and we have good evidence of poor dosing in chemotherapy etc, etc.
I'm also told we can't do this because enzymic test are expensive.
But hold on, we do glucose by enzymic methods and that's cheap as chips so why is creatinine more expensive.
Surely at the volumes we do in the UK the prices should be similar so where is the extra cost incurred.
Anyone have a view or an explanation?
Rick
Dr Rick Jones
Sen Lect, Yorkshire Centre Health Informatics, Univ of Leeds Consultant Chemical Pathologist, Leeds Teaching Hospitals NHS Trust NHS England, National Pathology Programme, Pathology IT Advisor [log in to unmask]
W: www.ychi.leeds.ac.uk/rgjones
T: 0113 343 4961
M: 07976 743 549
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