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ACB-CLIN-CHEM-GEN  November 2007

ACB-CLIN-CHEM-GEN November 2007

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Subject:

Re: eGFR

From:

Christine Collier <[log in to unmask]>

Reply-To:

Christine Collier <[log in to unmask]>

Date:

Mon, 19 Nov 2007 15:29:17 -0500

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (355 lines)

At the risk of raising my head too high (please be kind with your
responses!), I am not convinced about several issues in this debate.

First of all, if eGFR is simply a serum creatinine normalized for age and
gender (neither of which change rapidly), then changes in creatinine or
eGFR for an individual patient reciprocally mirror each other.  I have
always found this to be true with any individual time profiles I plot on
EXCEL.

A little off topic, but important then is that this should mean that a 30%
change in serum creatinine will also be reflected by roughly a 30% change
in eGFR. (percentage change)

If the importance of CKD is in the early detection of chronic disease,
then the important thing should be monitoring for significant long term
change (not the spot diagnosis of CKD using a global decision point of 60
- obviously there will always be the odd patient who presents with
CKD...but the idea is that this should be rare in the future).

The argument for not providing eGFR in our nephrology (dialysis) patients,
in ICU or in neonatal ICU is not exactly because of the unstable argument
as  "serum creatinine based estimations of kidney function also require
steady state" says one of our Ontario nephrologists.

For the other hospital units..."Hospital based docs are not eGFR naïve,
they are quite used to outpatient lab reporting.  Our recent Canadian
Nephrology Society guidelines (2006) makes no distinction between
community based and hospital based labs as far as the recommendation for
reporting goes."

"If eGFR report makes dose adjustment more likely, that will compensate
for possible differences between CG and MDRD calculations".  So, this
would be an argument for reporting in hospital units where age and gender
specific interpretation of serum creatinine is useful.

Have any labs noticed a decrease in the number of creatinine clearances
ordered, or suggested appropriate indications to limit these?

Cheers,
Christine

> We follow the same practice. Our IT department was able to set up the
report such an eGFR by MDRD is only calculated/reported when the patient
is not an inpatient.
>
> David Alter, MD
> Clinical/ Chemical Pathologist
> Pathology and Laboratory Medicine
> Spectrum Health - Blodgett
> 1840 Wealthy ST SE
> Grand Rapids, MI 49506
>
> 616 774 5123
>
> FX 616 774 5280
>
>
>
> ________________________________
>
> 	From: Clinical biochemistry discussion list
> [mailto:[log in to unmask]] On Behalf Of David Endres
> 	Sent: Monday, November 19, 2007 1:02 PM
> 	To: [log in to unmask]
> 	Subject: Re: eGFR
>
>
> 	Given reports that eGFR is inaccurate in many hospitalized
> patients and the unstable nature of many of these patients, we have
avoided automatically calculating eGFR on hospitalized patients.
>
> 	See the following reference:
>
> 	Poggio ED, Nef PC, Wang MS, et al. Performance of
> cockcroft-gault and modification of diet in renal disease equations in
estimating GFR in ill hospitalized patients. Am J Kidney Dis
> 2005;46:242-52.
>
> 	However, it does appear many hospitals in the states are
> reporting eGFR on all patients.  A few states have even mandated that it
be reported.
>
> 	David B. Endres, Ph.D.
> 	Professor of Clinical Pathology
> 	Keck School of Medicine
> 	University of Southern California
> 	LAC+USC Medical Center
> 	General Hospital, Room 2900
> 	1200 North State Street
> 	Los Angeles, CA 90033
> 	Phone: 323-226-7156
> 	Pager: 213-919-7433
> 	Fax: 1-323-843-9376
> 	Email: [log in to unmask]
>
> 	At 04:12 PM 11/19/2007 +0000, Marks Eileen (RQ6) RLBUHT wrote:
>
>
> 		Dear All
> 		We are under pressure to provide eGFR automatically on
> all inpatient U&E samples to facilitate eGFR requesting prior to
gadolinium MR scans.  We (reluctantly) already provide automatic eGFR on
all GP U&E samples but eGFR must be specifically requested on all non-GP
samples.
> 		Today I have been informed by our renal physicians that
> the majority of hospitals now do automatic eGFRs on all U&E samples and
we are out of step with the rest of the world!  Have most labs caved in
on automatic eGFR?
>
> 		Eileen Marks
>
>
>
> 		Dr Eileen Marks
>
> 		Clinical Director
>
> 		Department of Clinical Biochemistry and Metabolic
> Medicine
>
> 		Royal Liverpool University Hospital
>
> 		Prescot St
>
> 		Liverpool
>
> 		L7 8XP
>
> 		Telephone 0151 7064304
>
> 		This e-mail may contain confidential and/or proprietary
> information, some or all of which may be legally privileged. It is for
the intended recipient only. If any addressing or transmission error has
misdirected this e-mail, please notify the author by replying to this
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must not use, disclose, distribute, copy, print, or rely on this e-mail.
>
>
>
> 			-----Original Message-----
> 			From: Clinical biochemistry discussion list
> [mailto:[log in to unmask]]On Behalf Of Mainwaring-Burton
Richard (RGZ)
> 			Sent: Wednesday 14 November 2007 17:17
> 			To: [log in to unmask]
> 			Subject: Re: NPT eGFR and creatinine
> measurements
>
>
> 			Spotchem from Menarini also does creat
>
>
>
> 			with best wishes
> 			Richard
> 			Richard Mainwaring-Burton
> 			Consultant Biochemist
> 			Queen Mary's Hospital
> 			Sidcup, Kent
> 			020-8308-3084
> 			-----Original Message-----
> 			From: David Gaze
> [mailto:[log in to unmask]]
> 			Sent: 14 November 2007 12:13
> 			To: [log in to unmask]
> 			Subject: Re: NPT eGFR and creatinine
> measurements
>
>
>
> 			There is a NPT device for general chemistry
> panels (whole blood application but centrifugation inside device). It is
called the Piccolo.
>
>
> 			David C Gaze
> 			Cardiac Research Scientist
> 			Chemical Pathology
> 			Jenner Wing, Level 2
> 			St George's Healthcare NHS Trust
> 			London, SW17 0QT
> 			Tel:       +44 (0)20 8725 5878
> 			Fax:      +44 (0)20 8682 0744
> 			Email:   [log in to unmask]
> 			P Please consider the environment before
> printing this e-mail.
> 			-----Original Message-----
> 			From: Clinical biochemistry discussion list
> [mailto:[log in to unmask]] On Behalf Of Royle Chris
> 			Sent: 12 November 2007 10:18
> 			To: [log in to unmask]
> 			Subject: NPT eGFR and creatinine measurements
> 			Dear colleagues,
> 			Our Imaging colleagues are tackling the issue of
> possible side effects of gadolinium injections, and need an eGFR
measurement on patients coming for CMR scans. They tell us that other UK
centres are using NPT (whole blood?) creatinine meters for measuring
creatinine.
> 			Has anyone experience of such devices?
> 			Thanks,
> 			Chris
>
>
>
>
> 			Chris Royle
> 			Service Manager,
> 			Clinical Biochemistry and Haematology
> Departments,
> 			Royal Brompton and Harefield NHS Trust,
> 			Royal Brompton Hospital,
> 			Sydney Street,
> 			LONDON
> 			SW3 6NP
> 			phone:  + 44 (0)20 7351 8413
> 			fax:      + 44 (0)20 7351 8416
> 			e mail [log in to unmask]
> <mailto:[log in to unmask]>
>
>
>
>
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Christine Collier, PhD FCACB
Clinical Biochemist, Kingston General Hospital
Associate Professor, Queen's University
Phone: 613-533-2823
FAX:   613-533-2907

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