Routine reporting of estimated glomerular filtration rate (eGFR) in African Laboratories and the need for its increased utilisation in Clinical Practice. Simeon A Adebisi. Department of Chemical Pathology, College of Health Sciences, Benue State University. Makurdi. Benue State, Nigeria. Correspondence to: E-mail:
[email protected] Phone: +234 8033 5634 89 Summary Chronic Kidney Disease (CKD) is defined as the presence of markers of kidney damage or of estimated glomerular filtration rate (eGFR) 60 mL/min/1.73 m2 Caution while reporting eGFR and areas of research begging for attention on eGFR. The NKDEP Laboratory Working Group report28 states that the MDRD Study equation should only be used in individuals age 18 and older. The report also notes that the MDRD Study equation has not been validated for use with the elderly (over 70 years of age), pregnant women, patients with serious co-morbid conditions, or persons with extremes of body size, muscle mass, or nutritional status. Application of the equation to these patient groups may lead to errors in GFR estimation.28. The following areas of research are begging for research; validation of eGFR in Sickle Cell Disease patients, pregnancy, normadic Fulanis’ with small frame and patients with wasting diseases such as Diabetes Mellitus and HIV infections. Routine reporting of eGFR ; the global trend. Kidney disease is common, harmful, and treatable” 14. However, late stage CKD is associated with poor outcomes and high cost, disproportionately common among the elderly and the Black race. Thus, public health campaigns focus on early detection of CKD. To facilitate early detection of CKD, many national and international organizations now recommend automatic/ routine reporting of estimated glomerular filtration rate (eGFR) whenever serum creatinine is measured 3,7,,8,30,31,32,33,34,35. It is worth noting that the entire country of France mandates routine creatinine clearance based on the Cockcroft and Gault equation without notable reported problems12. Six months after publication of the Australasian Creatinine Consensus Working Group’s position statement in 2005, Over 69% of New Zealand laboratories report eGFR results with most requests for creatinine in patients aged >18 60
years 36 . Also most Australasian laboratories automatically report an estimated glomerular filtration rate (eGFR) (based on the Modification of Diet in Renal Disease [MDRD] formula) with results of serum creatinine tests in adults37. In the year 2005, approximately 20% of participants in the College of American Pathologists’ chemistry survey were reporting eGFR calculations routinely38; today, many healthcare centres in America report estimated GFR (eGFR) with routine blood work39. Routine reporting of eGFR ; why African laboratories must join. Laboratories in Africa should commence automatic reporting of eGFR for a number of reasons; · The sensitivity of serum creatinine (sCr) to identify CKD is low39. ·
In Nigeria, a representative country; screening for Chronic Kidney Disease (CKD) is hardly considered in the routine practice of the primary and secondary care medical officers9.
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Studies have shown that routine reporting of eGFR improved the documentation and identification of CKD by almost 50% 13.
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There is the possibility of reversing CKD if picked earlier.
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The high cost of treating CKD patients in advanced stages and the low per capital income status of the populace in Sub-Saharan Africa.
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Poor health infrastructure to manage advanced CKD patients in the Continent.
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Several studies 40,41,42 now show lack of awareness of CKD among non-nephrologists that is related, at least in part, to difficulty in interpreting serum creatinine concentrations (the reciprocal, nonlinear relationship between GFR and serum creatinine).
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Mathematical estimates of GFR [ as in eGFR] that incorporate creatinine concentration, as well as factors affecting creatinine production rates, such as size, gender, age and ethnic background, are more sensitive to changes in renal function than serum creatinine value alone.
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Recent guidelines define “action plans” for CKD according to the GFR, including referral to nephrologists at GFRs
