There is a danger with ethnicity correction that laboratory does correction,
and then GP does correction too.
To reduce risk of this, I have requested a Read Code helpful expanded to
"Glomerular filtration rate calculated by abbreviated Modification of Diet in
Renal Disease Study Group calculation adjusted for African American origin"
(likely to be 451G.) (not my submission!).
Additional comment on my part is that why should we be unhelpful to some
patients, and surely the right thing is to report both "egfr" (read code:
451E.) and "egfr adjusted for black ethnicity" (451G.) on all patients, the
requestor/receiver of results having to decide which applies in all cases and
certainly in all cases where ethnicity is unknown to laboratory. {obviously
at present the latter would not be Read Coded, as it takes six months to
come}
What ever the rights and wrongs on whether we adjust for creatinine methods
(we are in Bromley, but I know that others are not) what is important is that
data is properly audited later to see any differences about patient
classification and ideally outcomes.
Ian
Dr Ian R Bailey
Consultant Chemical Pathologist, Bromley Hospitals NHS Trust,UK
email: [log in to unmask]
Tel: 01689 864281
-----Original Message-----
From: Clinical biochemistry discussion list
[mailto:[log in to unmask]] On Behalf Of Reynolds Tim
Sent: 26 June 2006 12:58
To: [log in to unmask]
Subject: Re: e-GFR and ethnic origin.
The assay-specific creatinine parameters are probably enough to make it too
dangerous for GPs to do their own.
The data below shows what happened to our last 80,000-odd GP patients if we
use the different MDRD equations
Prevalence of chronic kidney disease based on the 3 different versions of the
4-variable MDRD equation. N= 80583.
ChKD Stage 5 4 3
2 1
eGFR (ml/min) <15 15 - 29 30 - 59 60 - 89
>90
eGFR186 176 (0.22%) 848 (1.05%) 17202 (21.35%)
53222 (66.06%) 9135 (11.34%)
eGFR175 196 (0.24%) 1098 (1.36%) 23121 (28.69%) 51094
(63.41%) 5074 (6.30%)
eGFR175corrected 190 (0.24%) 831 (1.03%) 10956
(13.60%) 43025 (53.41%) 25581 (31.75%)
It is clear that there is a great deal of difference in the group 3 patient
numbers...
TIM
************************************************************************
*************
Prof. Tim Reynolds,
Queen's Hospital,
Belvedere Rd,
Burton-on-Trent,
Staffordshire,
DE13 0RB
work tel: 01283 511511 ext. 4035
work fax: 01283 593064
work email: [log in to unmask]
home email: [log in to unmask]
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-----Original Message-----
From: Clinical biochemistry discussion list
[mailto:[log in to unmask]] On Behalf Of David Robertshaw
Sent: 23 June 2006 10:04
To: [log in to unmask]
Subject: Re: e-GFR and ethnic origin.
Why don't we let GPs do there own calculations, (there are plenty of formulae
on the Internet). So long as they have the appropriate factor from the Lab
relevant to the Creatinine method the GP will have all the information they
need ie Height, Weight, (for surface area) sex, age and ethnicity. That way
the GP will get the right answerand it won't cost the Labs money for extra
paper reports, (which we shouldn't be sending out anyway), explaining the
limitations of result they are getting.
>>> "Colley, Michael" <[log in to unmask]> 22/06/06
17:08:36 >>>
Perhaps we should just report the calculated eGFR without ethnic allowance
then the GP computer, which will know the "ethnicity" of the patient
(?!)
can do the appropriate calculation.
M.
-----Original Message-----
From: Alan Munday [mailto:[log in to unmask]]
Sent: 22 June 2006 15:54
To: [log in to unmask]
Subject: e-GFR and ethnic origin.
Hi,
Because we do not believe that we get the patients' ethnic origin reported
accurately (or at all) on a significant proportion of requests, we had taken
the decision to report estimated GFR without making the correction for ethnic
origin and to add a comment to this effect to all reports.
However, a local GP has pointed out that if we report this electronically and
his practice computer system files it automatically, there is then an
incorrect result on a number of patients' records.
While this may be picked up when reading the patient's record, electronic
searches of the system for purposes such as QOF etc. will produce inaccurate
results. Most importantly of course, a patient's record has the 'wrong'
result in it.
How are others dealing with the inaccurate reporting of ethnic origin in
requests, for renal function or any other investigation ?
Cheers
Alan
Alan Munday
Senior Biomedical Scientist/
GP IT Co-ordinator
Clinical Biochemistry
University Hospital Lewisham
[log in to unmask]
Tel: 020 8333 3030 Ext. 6257
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