Assessing the status of European laboratories in evaluating biomarkers for chronic kidney diseases (CKD) and recommendations for improvement: insights from the 2022 EFLM Task Group on CKD survey. - 2024
Assessing the status of European laboratories in evaluating biomarkers for chronic kidney diseases (CKD) and recommendations for improvement: insights from the 2022 EFLM Task Group on CKD survey.
creatinine; cystatin C; equations; glomerular filtration rate; recommendations; survey; Clinical Biochemistry; Biochemistry (medical); General Medicine
Abstract :
[en] [en] OBJECTIVES: Chronic kidney disease (CKD) is a global health issue, ranking as the third leading cause of death worldwide. CKD diagnosis and management depend on clinical laboratory tests, necessitating consistency for precise patient care. Global harmonization of CKD testing through clinical practice guidelines (CPGs) is recommended. Prior to CPG development, assessing the current CKD testing landscape is crucial. In 2022, the European Federation of Laboratory Medicine (EFLM) conducted an online survey among European laboratories associated with EFLM, evaluating CKD testing practices, including new glomerular filtration rate (GFR) estimation methods. This report summarizes the 2022 survey findings and offers recommendations for improving CKD test standardization.
METHODS: An online survey was conducted in November 2022 using a questionnaire hosted on LimeSurvey sent to European laboratories affiliated with the EFLM. The survey results were recorded in Excel files and analysed.
RESULTS: The results highlight significant discrepancies among countries in unit expression, methods, cystatin C use, and GFR calculation equations. Additionally, limited attention to pediatric renal biology specifics, varied proteinuria and albuminuria result expressions, and limited awareness of GFR measurement methods through iohexol clearance are noted.
CONCLUSIONS: In an effort to enhance the standardization of crucial biomarkers utilized in nephrology for evaluating renal function and diagnosing kidney injuries, the EFLM Task Group on CKD suggests nine practical recommendations tailored for European laboratories. The group is confident that implementing these measures will minimize result expression discrepancies, ultimately leading to enhanced patient care.
Disciplines :
Laboratory medicine & medical technology Urology & nephrology
Author, co-author :
Cavalier, Etienne ; Centre Hospitalier Universitaire de Liège - CHU > > Service de chimie clinique
Makris, Konstantinos; Department of Clinical Biochemistry, KAT General Hospital, Athens, Greece
Portakal, Oytun; Department of Biochemistry, Hacettepe University Medical School, Ankara, Türkiye
Nikler, Ana; Department of Medical Laboratory Diagnostics, University Hospital "Sveti Duh", Zagreb, Croatia
Datta, Pradip; Siemens Healthineers Diagnostics, Newark, DE, USA
Zima, Tomas; Institute of Medical Chemistry and Laboratory Medicine, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
Delanaye, Pierre ; Centre Hospitalier Universitaire de Liège - CHU > > Service de néphrologie
EFLM Task Group on CKD
Language :
English
Title :
Assessing the status of European laboratories in evaluating biomarkers for chronic kidney diseases (CKD) and recommendations for improvement: insights from the 2022 EFLM Task Group on CKD survey.
Rutter H, Horton R, Marteau TM. Global burden of disease 2019: GBD cause and risk summaries chronic kidney disease. Lancet 2020;396: 152–3.
KDIGO Working Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int 2013;3:1–163.
Levin A, Tonelli M, Bonventre J, Coresh J, Donner JA, Fogo AB, et al. Global kidney health 2017 and beyond: a roadmap for closing gaps in care, research, and policy. Lancet 2017;390:1888–917.
Biljak VR, Grubb A, Guerra IC, Cavalier E, Raymondo S, Sierra-Amor R, et al. The first step in creating national Chronic Kidney Disease (CKD) guidelines-a questionnaire. Biochem Med 2019;29:1–30.
Inker LA, Eneanya ND, Coresh J, Tighiouart H, Wang D, Sang Y, et al. New creatinine- and cystatin C-based equations to estimate GFR without race. N Engl J Med 2021;385:1737–49.
Pottel H, Björk J, Courbebaisse M, Couzi L, Ebert N, Eriksen BO, et al. Development and validation of a modified full age spectrum creatinine-based equation to estimate glomerular filtration rate. Ann Intern Med 2021;174:183–91.
Levey AS, Stevens La, Schmid CH, Zhang YL, Castro AF, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med 2009;150:604–12.
Levey AS, Tighiouart H, Titan SM, Inker LA. Estimation of glomerular filtration rate with vs without including patient race. JAMA Intern Med 2020;180:793–5.
Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999;130:461–70.
Cockcroft D, Gault M. Prediction of creatinine clearance from serum creatinine. Nephron 1976;16:31–41.
Nyman U, Grubb A, Larsson A, Hansson LO, Flodin M, Nordin G, et al. The revised Lund-Malmö GFR estimating equation outperforms MDRD and CKD-EPI across GFR, age and BMI intervals in a large Swedish population. Clin Chem Lab Med 2014;52: 815–24.
Pottel H, Hoste L, Dubourg L, Ebert N, Schaeffner E, Eriksen BO, et al. An estimated glomerular filtration rate equation for the full age spectrum. Nephrol Dial Transplant 2016;31:798–806.
Inker LA, Schmid CH, Tighiouart H, Eckfeldt JH, Feldman HI, Greene T, et al. Estimating glomerular filtration rate from serum creatinine and cystatin C. N Engl J Med 2012;367:20–9.
Grubb A, Horio M, Hansson LO, Björk J, Nyman U, Flodin M, et al. Generation of a new cystatin C-based estimating equation for glomerular filtration rate by use of 7 assays standardized to the international calibrator. Clin Chem 2014;60:974–86.
Larsson A, Malm J, Grubb A, Hansson LO. Calculation of glomerular filtration rate expressed in mL/min from plasma cystatin C values in mg/L. Scand J Clin Lab Invest 2004;64:25–30.
Hoek FJ, Kemperman FAW, Krediet RT. A comparison between cystatin C, plasma creatinine and the Cockcroft and Gault formula for the estimation of glomerular filtration rate. Nephrol Dial Transplant 2003; 18:2024–31.
Schwartz GJ, Haycock GB, Edelmann CM, Spitzer A. A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics 1976;58:259.
Schwartz GJ, Muñoz A, Schneider MF, Mak RH, Kaskel F, Warady BA, et al. New equations to estimate GFR in children with CKD. J Am Soc Nephrol 2009;20:629.
Schwartz GJ, Schneider MF, Maier PS, Moxey-Mims M, Dharnidharka VR, Warady BA, et al. Improved equations estimating GFR in children with chronic kidney disease using an immunonephelometric determination of cystatin C. Kidney Int 2012;82:445–53.
Piéroni L, Delanaye P, Boutten A, Bargnoux AS, Rozet E, Delatour V, et al. A multicentric evaluation of IDMS-traceable creatinine enzymatic assays. Clin Chim Acta 2011;412:2070–5.
Cobbaert CM, Baadenhuijsen H, Weykamp CW. Prime time for enzymatic creatinine methods in pediatrics. Clin Chem 2009;55:549–58.
Delanaye P, Schaeffner E, Cozzolino M, Langlois M, Plebani M, Ozben T, et al. The new, race-free, chronic kidney disease epidemiology consortium (CKD-EPI) equation to estimate glomerular filtration rate: is it applicable in Europe? A position statement by the European Federation of clinical chemistry and laboratory medicine (EFLM). Clin Chem Lab Med 2022;61:44–7.
Gansevoort RT, Anders HJ, Cozzolino M, Fliser D, Fouque D, Ortiz A, et al. What should European nephrology do with the new CKD-EPI equation? Nephrol Dial Transplant 2023;38:1.