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ACB-CLIN-CHEM-GEN  June 2010

ACB-CLIN-CHEM-GEN June 2010

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Subject:

Re: GFR

From:

"John Francis Doran (ABM ULHB - Biochemistry)" <[log in to unmask]>

Reply-To:

John Francis Doran (ABM ULHB - Biochemistry)

Date:

Fri, 11 Jun 2010 18:01:06 +0100

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (143 lines)

There is an obvious benefit- QOF! aka quasi officious fiddling
John

-----Original Message-----
From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Jonathan Kay
Sent: 11 June 2010 15:13
To: [log in to unmask]
Subject: Re: GFR

Patients may be referred to nephrologists earlier, and low eGFR may be a risk factor... but what's the evidence for benefit?

Thanks

Jonathan

> From: "Miller Adrian (University Hospital Of South Manchester NHS Foundation Trust)" <[log in to unmask]>
> Date: 11 June 2010 10:52:08 GMT+01:00
> To: [log in to unmask]
> Subject: Re: GFR
> Reply-To: "Miller Adrian (University Hospital Of South Manchester NHS Foundation Trust)" <[log in to unmask]>
> 
> Eerily-timed (from a mailbase perspective)
> 
> The Lancet, Volume 375, Issue 9731, Pages 2073 - 2081, 12 June 2010
> 
> Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis
> 
> Background
> 
> Substantial controversy surrounds the use of estimated glomerular filtration rate (eGFR) and albuminuria to define chronic kidney disease and assign its stages. We undertook a meta-analysis to assess the independent and combined associations of eGFR and albuminuria with mortality.
> 
> Findings
> 
> The analysis included 105 872 participants (730 577 person-years) from 14 studies with urine albumin-to-creatinine ratio (ACR) measurements and 1 128 310 participants (4 732 110 person-years) from seven studies with urine protein dipstick measurements. In studies with ACR measurements, risk of mortality was unrelated to eGFR between 75 mL/min/1*73 m2 and 105 mL/min/1*73 m2 and increased at lower eGFRs. Compared with eGFR 95 mL/min/1*73 m2, adjusted HRs for all-cause mortality were 1*18 (95% CI 1*05-1*32) for eGFR 60 mL/min/1*73 m2, 1*57 (1*39-1*78) for 45 mL/min/1*73 m2, and 3*14 (2*39-4*13) for 15 mL/min/1*73 m2. ACR was associated with risk of mortality linearly on the log-log scale without threshold effects. Compared with ACR 0*6 mg/mmol, adjusted HRs for all-cause mortality were 1*20 (1*15-1*26) for ACR 1*1 mg/mmol, 1*63 (1*50-1*77) for 3*4 mg/mmol, and 2*22 (1*97-2*51) for 33*9 mg/mmol. eGFR and ACR were multiplicatively associated with risk of mortality without evidence of interaction. Similar findings were recorded for cardiovascular mortality and in studies with dipstick measurements.
> 
> Interpretation
> 
> eGFRless than 60 mL/min/1*73 m2 and ACR 1*1 mg/mmol (10 mg/g) or more are independent predictors of mortality risk in the general population. This study provides quantitative data for use of both kidney measures for risk assessment and definition and staging of chronic kidney disease.
> 
> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2810%2960674-5/abstract?elsca1=TL-110610&elsca2=email&elsca3=segment

On 10 Jun 2010, at 09:48, Hallworth Mike (RLZ) wrote:

> 
> Hi Anders
> 
> I'm glad we amuse you, but it is worth noting that the introduction of
> eGFR reporting in the UK has had a significant impact on getting faster
> referrals to specialist renal care, with one report stating that the
> number of patients referred late for specialist care fell from 38% to
> 25% following eGFR introduction (Bebb and Burden, BMJ 2007; 334: 1287).
> This is supported by data from the UK Renal Registry. So there is
> evidence that patients benefit, even though eGFR may not satisfy the
> metrologists!
> 
> Mike
> 
> 
> -----Original Message-----
> From: Clinical biochemistry discussion list
> [mailto:[log in to unmask]] On Behalf Of Anders Kallner
> Sent: 09 June 2010 17:19
> To: [log in to unmask]
> Subject: GFR
> 
> It amuses me to note that the UK (and US)colleagues still seem to
> believe that S-Creatinine concentrations can be used to diagnose CKD in
> spite of the large biological inter individual variation that Callum
> Fraser (Dundee) nicely demonstrated in 80-ies. The variation is not
> decreased by multiplying the measured S-Creatinine concentration by one
> or other constant. On the contrary the gender and age variations
> increase by the operation. You may still very well use the S-Creatinine
> concentration to monitor disease and the mutilated value, erroneously
> referred to as GFR, as well.  
> Anders Kallner
> 
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