Clinical chemistry | 2019
Optimal Use of Biomarkers for Chronic Kidney Disease.
Abstract
The primary laboratory tests for diagnosis of chronic kidney disease (CKD)9 are serum/plasma/blood creatinine with calculation of estimated glomerular filtration rate (eGFR) and urine albumin–creatinine ratio (UACR). Cystatin C is becoming a secondary test for estimating eGFR in some clinical situations. Urine total protein and the protein–creatinine ratio are also used to monitor patients with more advanced CKD. The US Renal Data System 2018 reports that data from the National Health and Nutrition Examination Survey provide an estimate that 15% of the US population meet the laboratory criteria for CKD based on the Kidney Disease Improving Global Outcomes (KDIGO) 2012 Clinical Practice Guideline definition of GFR 30 mg/g (3 mg/mmol).\n\nIn the years from 2010 to 2018, 80%–90% of laboratories in the US have reported eGFR along with creatinine, yet patient awareness of having CKD continues to be poor. In the 2013–2016 US National Health and Nutrition Examination Survey data, only 8% of people with eGFR 30 mg/g (3 mg/mmol) were aware of having CKD.\n\nIn this Q&A, a panel of experts in laboratory medicine and in nephrology examine laboratory ordering, testing, and reporting practices and recommend how those practices can be improved to better serve patients with CKD.\n\nWhat is a kidney profile and when should it be ordered? \n\nJoseph Vassalotti: The American Diabetes Association, KDIGO, and the National Kidney Foundation (NKF) s Kidney Disease Outcomes Quality Initiative recommend eGFR and UACR as the tests for CKD targeted for the major risk groups, including diabetes and hypertension. The combination of eGFR and UACR guides therapeutic interventions and predicts risk for CKD progression as well as cardiovascular events, and mortality. The UACR is …