Winter 2007

H E A L T H   T E C H N O L O G Y
Introducing a new way to recognize reduced kidney function: the eGFR

  
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Labs in many provinces now routinely do the calculations automatically and report an estimate of GFR along with the serum creatinine result.

By Dr. Brendan Barrett

Identifying reduced kidney function can be challenging. Serum creatinine levels do not rise appreciably until kidney function falls by almost 50%. The lab normal range for serum creatinine is not always a reliable way to identify those with reduced kidney function. This is especially the case in older females. Estimates of GFR, or creatinine clearance, derived from the serum creatinine and other data are a more reliable way to identify those with reduced kidney function. Many physicians will be familiar with the Cockroft-Gault equation and may use it or another equation within their current practice. However, this requires the physician to take the time to do the necessary calculations. Labs in many provinces now routinely do the calculations automatically and report an estimate of GFR along with the serum creatinine result. This estimate (also called eGFR) takes into account the patients age, sex and usually race.

Work is currently ongoing to permit automatic reporting by labs in this province of eGFR along with serum creatinine results when creatinine levels are ordered. The serum creatinine assays will be standardized as part of this process in order to optimize the accuracy of eGFR results. It is anticipated that this may take a few more months.

The eGFR is not accurate when kidney function is closer to normal. For this reason, labs in this province have been asked not to report a number when the eGFR comes out to be above 60 mls/min/1.73m2. You should also be aware that eGFR, like all serum creatinine based measures of kidney function is not a very precise measure. In general, the true kidney function is likely to be within 30% of the reported eGFR about 90% of the time. Serial testing of serum creatinine over time gives a better idea of a given patient’s usual kidney function. eGFR is also only appropriate as a measure in the setting of stable or slowly changing kidney function.

Further information about interpreting the eGFR and links to resources to help practitioners assess and manage people with reduced kidney function will be forthcoming through the NLMA as the eGFR is introduced in this province.

Dr. Brendan Barrett is medical director of the provincial kidney program.

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