EGFR: is It Ready for Early Identification of CKD?

Overview

Journal Clin J Am Soc Nephrol

Specialty Nephrology

Date 2008 Aug 1

PMID 18667739

Citations 6

Authors

Michal L Melamed

Carolyn Bauer

Thomas H Hostetter

Affiliations

Soon will be listed here.

Abstract

Reporting estimated glomerular filtration rate (eGFR) with serum creatinine simply provides the information for which the serum creatinine was ordered in the first place. Mass or universal screening is not the purpose of eGFR reporting. Furthermore, such mass screening does not seem justified. Rather, testing of high-risk groups with eGFR and urinary albumin is useful. Population estimates of the prevalence of chronic kidney disease in the United States that use the Kidney Disease Outcomes Quality Initiative staging system lead to disturbingly high estimates. Many of these people are elderly with marginally depressed GFRs and for whom there are no known therapeutic implications. However, an even more disturbing fraction of people with serious and progressive renal disease are not diagnosed, counseled, or treated. Reporting of eGFR is only one tool in attempting to rectify this latter problem. Nephrologists need to educate patients and their primary care colleagues in the use of this tool.

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References

Hostetter T, Meyer T . The development of clearance methods for measurement of glomerular filtration and tubular reabsorption. Am J Physiol Renal Physiol. 2004; 287(5):F868-70. DOI: 10.1152/classicessays.00009.2004. View

Sarnak M, Levey A, Schoolwerth A, Coresh J, Culleton B, Hamm L . Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and.... Hypertension. 2003; 42(5):1050-65. DOI: 10.1161/01.HYP.0000102971.85504.7c. View

Go A, Chertow G, Fan D, McCulloch C, Hsu C . Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004; 351(13):1296-305. DOI: 10.1056/NEJMoa041031. View

Menon V, Shlipak M, Wang X, Coresh J, Greene T, Stevens L . Cystatin C as a risk factor for outcomes in chronic kidney disease. Ann Intern Med. 2007; 147(1):19-27. DOI: 10.7326/0003-4819-147-1-200707030-00004. View

. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). SHEP Cooperative Research Group. JAMA. 1991; 265(24):3255-64. View

Rule A, Larson T, Bergstralh E, Slezak J, Jacobsen S, Cosio F . Using serum creatinine to estimate glomerular filtration rate: accuracy in good health and in chronic kidney disease. Ann Intern Med. 2004; 141(12):929-37. DOI: 10.7326/0003-4819-141-12-200412210-00009. View

Chan M, Dall A, Fletcher K, Lu N, Trivedi H . Outcomes in patients with chronic kidney disease referred late to nephrologists: a meta-analysis. Am J Med. 2007; 120(12):1063-70. DOI: 10.1016/j.amjmed.2007.04.024. View

Stevens L, Fares G, Fleming J, Martin D, Murthy K, Qiu J . Low rates of testing and diagnostic codes usage in a commercial clinical laboratory: evidence for lack of physician awareness of chronic kidney disease. J Am Soc Nephrol. 2005; 16(8):2439-48. DOI: 10.1681/ASN.2005020192. View

Bauer C, Melamed M, Hostetter T . Staging of chronic kidney disease: time for a course correction. J Am Soc Nephrol. 2008; 19(5):844-6. DOI: 10.1681/ASN.2008010110. View

10.

Tseng C, Kern E, Miller D, Tiwari A, Maney M, Rajan M . Survival benefit of nephrologic care in patients with diabetes mellitus and chronic kidney disease. Arch Intern Med. 2008; 168(1):55-62. DOI: 10.1001/archinternmed.2007.9. View

11.

Wyatt C, Konduri V, Eng J, Rohatgi R . Reporting of estimated GFR in the primary care clinic. Am J Kidney Dis. 2007; 49(5):634-41. DOI: 10.1053/j.ajkd.2007.02.258. View

12.

McClellan W, Knight D, KARP H, Brown W . Early detection and treatment of renal disease in hospitalized diabetic and hypertensive patients: important differences between practice and published guidelines. Am J Kidney Dis. 1997; 29(3):368-75. DOI: 10.1016/s0272-6386(97)90197-9. View

13.

Coresh J, Selvin E, Stevens L, Manzi J, Kusek J, Eggers P . Prevalence of chronic kidney disease in the United States. JAMA. 2007; 298(17):2038-47. DOI: 10.1001/jama.298.17.2038. View

14.

Nathan D, Genuth S, Lachin J, Cleary P, Crofford O, Davis M . The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993; 329(14):977-86. DOI: 10.1056/NEJM199309303291401. View

15.

Lewis E, Hunsicker L, Clarke W, Berl T, Pohl M, Lewis J . Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med. 2001; 345(12):851-60. DOI: 10.1056/NEJMoa011303. View

16.

Quartarolo J, Thoelke M, Schafers S . Reporting of estimated glomerular filtration rate: effect on physician recognition of chronic kidney disease and prescribing practices for elderly hospitalized patients. J Hosp Med. 2007; 2(2):74-8. DOI: 10.1002/jhm.172. View

17.

Jaar B, Khatib R, Plantinga L, Boulware L, Powe N . Principles of screening for chronic kidney disease. Clin J Am Soc Nephrol. 2007; 3(2):601-9. PMC: 6631080. DOI: 10.2215/CJN.02540607. View

18.

Akbari A, Swedko P, Clark H, Hogg W, Lemelin J, Magner P . Detection of chronic kidney disease with laboratory reporting of estimated glomerular filtration rate and an educational program. Arch Intern Med. 2004; 164(16):1788-92. DOI: 10.1001/archinte.164.16.1788. View

19.

Boulware L, Troll M, Jaar B, Myers D, Powe N . Identification and referral of patients with progressive CKD: a national study. Am J Kidney Dis. 2006; 48(2):192-204. DOI: 10.1053/j.ajkd.2006.04.073. View

20.

Brenner B, Cooper M, de Zeeuw D, Keane W, Mitch W, Parving H . Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med. 2001; 345(12):861-9. DOI: 10.1056/NEJMoa011161. View