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As I keep telling students - treat the patient not the result! dj From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Mike Bosomworth Sent: 30 July 2014 10:28 To: [log in to unmask] Subject: Re: CKD Not wishing to be provocative but don't we and perhaps even more so our users take our results too literally i.e eGFR=45ml/min/1.73m2 then the eGFR or even the true GFR must be exactly that! Also guidance recommends an initial result <60ml/min/1.73m2, should be checked before a diagnosis is made. To my mind the eGFR result and the imminent AKI Stage result (alert) are really saying go and review the patient, both are an estimate / guide only and should not be taken literally and certainly should not be viewed in isolation. Of course in addition to detecting / staging CKD our serum creatinine results are used in algorithms to determine dosage of renally excreted drugs, the dosage of which is going to be determined at least as much by the creatinine method and algorithm used as it is by the patient's true GFR. That is probably a topic for another day! Have a good one Mike Dr. Mike Bosomworth Clinical Service Lead for Blood Sciences and Specialist Laboratory Medicine. Tel. 0113 3922340 Mobile 07789 174344 >>> Jonathan Kay <[log in to unmask]<mailto:[log in to unmask]>> 25/07/2014 12:27 >>> Really interesting topic. There are many guidelines/ rule-based systems/ DSS that have decision points where the noise is high. I think the answer is: 1 Assess the systems's overall performance even knowing that individual components may be wrong. This may be against alternative systems or having no system at all. 2 Not make important decisions based on individual input values (which is really a subset of 1). Jonathan On 25 Jul 2014, at 11:19, Jonathan Middle <[log in to unmask]<mailto:[log in to unmask]>> wrote: I looked at the Table in the link John sent and was interested in the eGFR values used in the stratification of CKD. Is anyone concerned about whether the uncertainty requirements for eGFR estimation that would enable laboratories accurately and reliably to discriminate between values of, say, 44 & 45 mL/min/1.73m^2, can be achieved? ------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content. 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