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ACB-CLIN-CHEM-GEN  2006

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Subject:

Re: feedback on U and E profile question

From:

Jonathan Kay <[log in to unmask]>

Reply-To:

Jonathan Kay <[log in to unmask]>

Date:

Sun, 8 Oct 2006 10:54:59 +0100

Content-Type:

text/plain

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text/plain (123 lines)

Thanks.

Our findings on the effects of varying what is included in some  
common groups was published in a Focus abstract:
Reduction of workload by redefinition of test profiles
McVittie,J.D., Kay,J.D.S., Keenan,J.ÿ
Annals of Clinical Biochemistry (1988); 25, S1, 188-189

Is there any evidence that measuring plasma urea reliably detects the  
state of hydration? I challenge students every year with this, but  
the bottle of champagne remains unopened. "Everyone knows it" doesn't  
win the prize.

Jonathan

On 6 Oct 2006, at 16:37, Myers Martin (Dr) wrote:

> 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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