Prevalence of Estimated GFR Reporting Among US Clinical Laboratories

doi:10.1053/j.ajkd.2008.05.023

American Journal of Kidney Diseases

Volume 52, Issue 4, October 2008, Pages 778-787

https://doi.org/10.1053/j.ajkd.2008.05.023 Get rights and content

Background

Routine laboratory reporting of estimated glomerular filtration rate (eGFR) may help clinicians detect kidney disease. The current national prevalence of eGFR reporting in clinical laboratories is unknown; thus, the extent of the situation of laboratories not routinely reporting eGFR with serum creatinine results is not quantified.

Design

Observational analysis.

Setting

National Kidney Disease Education Program survey of clinical laboratories conducted in 2006 to 2007 by mail, web, and telephone follow-up.

Participants

A national random sample, 6,350 clinical laboratories, drawn from the Federal Clinical Laboratory Improvement Amendments database and stratified by 6 major laboratory types/groupings.

Predictors

Laboratory reports serum creatinine results.

Outcomes

Reporting eGFR values with serum creatinine results.

Measurements

Percentage of laboratories reporting eGFR along with reporting serum creatinine values, reporting protocol, eGFR formula used, and style of reporting cutoff values.

Results

Of laboratories reporting serum creatinine values, 38.4% report eGFR (physician offices, 25.8%; hospitals, 43.6%; independents, 38.9%; community clinics, 47.2%; health fair/insurance/public health, 45.5%; and others, 43.2%). Physician office laboratories have a reporting prevalence lower than other laboratory types (P < 0.001). Of laboratories reporting eGFR, 66.7% do so routinely with all adult serum creatinine determinations; 71.6% use the 4-variable Modification of Diet in Renal Disease Study equation; and 45.3% use the “>60 mL/min/1.73 m²” reporting convention. Independent laboratories are least likely to routinely report eGFR (50.6%; P < 0.05) and most likely to report only when specifically requested (45.4%; P < 0.05). High-volume laboratories across all strata are more likely to report eGFR (P < 0.001).

Limitations

Self-reporting by laboratories, federal database did not have names of laboratory directors/managers (intended respondents), assumed accuracy of federal database for sample purposes.

Conclusions

Routine eGFR reporting with serum creatinine values is not yet universal, and laboratories vary in their reporting practices.

Section snippets

Study Population and Sampling

On November 22, 2005, NKDEP obtained the Clinical Laboratory Improvement Amendments (CLIA) database from the Centers for Medicare & Medicaid Services, which includes all laboratories that hold or are seeking 1 of 4 types of certification required to perform laboratory tests on humans in the United States. The file includes laboratory/facility type (eg, community clinic and hospital), testing specialties and subspecialties, related annual test volumes, and other information. Of the nearly

Serum Creatinine Reporting

Of laboratories performing routine chemistry tests for adult patients (survey item 1), 63.8% report a serum creatinine result (Table 3). Serum creatinine reporting is highest in hospital (91.5%) and independent (70.7%) laboratories and lowest in physician office (45.9%) and other (48.4%) laboratories. Differences for the percentage of reporting across strata were significant at a level of P less than 0.001. When reporting serum creatinine in milligrams per deciliter (survey item 2), 90.5%

Discussion

eGFR is currently the clinical standard for assessing kidney function; for detecting early CKD, monitoring kidney function, and assessing the effectiveness of treatment plans. NKDEP, along with others in the kidney community, has encouraged widespread adoption of eGFR reporting with all determinations for those 18 years and older to facilitate earlier diagnosis and treatment of CKD. This is especially important in the primary care setting, in which clinicians may routinely rely on serum

Acknowledgements

We gratefully acknowledge the assistance of Anna Zawislanski, MPH, from the NKDEP.

Support: This research was funded by the NKDEP, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health.

Financial Disclosure: None.

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: Originally published online as doi:10.1053/j.ajkd.2008.05.023 on August 1, 2008.

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Special ArticlePrevalence of Estimated GFR Reporting Among US Clinical Laboratories

Background

Design

Setting

Participants

Predictors

Outcomes

Measurements

Results

Limitations

Conclusions

Section snippets

Study Population and Sampling

Serum Creatinine Reporting

Discussion

Acknowledgements

Standards of medical care in diabetes—2007

Diabetes Care

National Kidney Foundation practice guidelines for chronic kidney disease: Evaluation, classification, and stratification

Ann Intern Med

A more accurate method to estimate glomerular filtration rate from serum creatinine: A new prediction equationModification of Diet in Renal Disease Study Group

Ann Intern Med

Detection of chronic kidney disease with laboratory reporting of estimated glomerular filtration rate and an educational program

Arch Intern Med

Reporting of estimated glomerular filtration rate: Effect on physician recognition of chronic kidney disease and prescribing practices for elderly hospitalized patients

J Hosp Med

Special Article
Prevalence of Estimated GFR Reporting Among US Clinical Laboratories