Frank
The FAQ sheet issued by the DoH highlighted the issues about application
of equations to historical data. If your GP did not apply the correct
slope and intercept to the equation then he could have over or
under-estimated the prevalence of CKD depending on whether the assay
reported is positively or negatively biased against IDMS values.
I have applied the abbreviated MDRD 175 equation to 17,494 patients
samples arriving from general practice over a 3 month period. Using the
Roche Rate Blanked and compensated Kinetic Jaffe with a slope of 1.004
and intercept of 3.08 (NEQAS derived)on 3 Modular SWAs we found The
following:-
eGFR n % population
ml/min/1.73m2
<15 17 0.1
15-30 207 1.18
30-60 2808 16.05
60-90 8750 50.2
>90 5710 32.64
The CKD prevalence is a little better than the 27% found by the GP
responding to Hillingdon.
WE have been reporting eGFR for more than 2 years now to both primary
care and secondary care. All the caveats about application patients have
to be appreciated. WE apply the equation to males if the creatinine is
>106 umol/L and in females >80 umol/L. Application of an appropriate
algorithm that indicates the need to check for protein and blood in
urine, the need to assess BP and treat accordingly means that our renal
physicians have not been overwhelmed. Referrals went up significantly,
but renal clinic attendances remained constant as most of the additional
referrals were managed by application of the algorithm by the referring
clinician.
Here are undoubtedly significant public health benefits resulting from
preservation of renal function which are well documented. Early
treatment will reduce cardiovascular risk and impact on the metabolic
problems associated with the deterioration. The health economics could
be further characterized, but I think there is plenty of evidence to
suggest that the adoption of eGFR enables well characterized
interventions to be applied vis a clinical protocols that can be
utilized easily by non specialists.
Regards
Bill Bartlett.
Sad Person replying to a mailbase e-mail on Friday evening at 21:00hrs!
At 11:37 2006-04-28, Frank Murphy wrote:
>Sending out eGFR's on all our GP U/E requests has elicited some
>interesting GP responses.
>Not least is an email from one GP saying he has retrospectively applied
>our '175' formula to 3240 of his patients 27% of whom appear to have an
>indicated stage 3-5 renal impairment. He further comments that he has a
>list size of around 12,600.
>
>Any comments?
>
>Frank Murphy
>Principal Biochemist
>Hillingdon Hospital
>
>--------------------------------------------------------------------
>
>IMPORTANT NOTE:
>This E-Mail may contain information which is sensitive, confidential
>and/or protected by law (e.g.; Data Protection Act,
>Copyright & Intellectual Property Rights Act).
>This information may only be used for the purposes for which it is
>supplied. If you are not the intended recipient of this E-mail you
>may not use this information for any purpose or disclose it to any
>other person and the sender would appreciate a reply E-mail
>confirming that all of the information contained herein has been
>erased.
>
>--------------------------------------------------------------------
><<<<gwavasig>>>>
>
>------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.
>
>ACB Web Site
>http://www.acb.org.uk
>List Archives
>http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html
>List Instructions (How to leave etc.)
>http://www.jiscmail.ac.uk/
------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.
ACB Web Site
http://www.acb.org.uk
List Archives
http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html
List Instructions (How to leave etc.)
http://www.jiscmail.ac.uk/
**********************************************************************
This email contains proprietary information some or all of which may be legally privileged.
It is for the intended recipient(s) only. If an addressing or transmission error has misdirected this e-mail, please notify the author by replying to this e-mail.
If you are not the intended recipient you must not use, disclose, distribute, copy, print, or rely on this e-mail.
Please note, the information contained in this e-mail may be subject to disclosure under the Freedom of Information Act 2000 or the Data Protection Act 1998
This footnote also confirms that this email message has been swept by McAfee Group Shield for the presence of computer viruses.
www.McAfee.com
**********************************************************************
------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.
ACB Web Site
http://www.acb.org.uk
List Archives
http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html
List Instructions (How to leave etc.)
http://www.jiscmail.ac.uk/
|