Postgraduate School of Nephrology, Milano Bicocca University, Milan, Italy.
J Nephrol. 2013 Mar-Apr;26(2):396-402. doi: 10.5301/jn.5000172. Epub 2012 Jun 7.
Only limited data are available on the diffusion of isotope dilution mass spectrometry (IDMS)-traceable methods used for serum creatinine measurement and on estimated glomerular filtration rate (eGFR) reporting.
A questionnaire was addressed to accredited laboratories in Lombardy, Italy, including the following issues: method of creatinine measurement, instrument model, IDMS calibration traceability, reference intervals reported by sex and age, eGFR reporting, eGFR formula used and information about the eGFR value reported in patient records. A parallel questionnaire was addressed to nephrology centers and included the following: knowledge of methods for serum creatinine measurement in their center, usefulness of eGRF reporting and opinions on the need for educational initiatives.
Seventy-two percent of 72 laboratories and 89% of 47 nephrology centers responded to the questionnaires. Among the methods used for serum creatinine measurement, 87% were IDMS traceable and 30% were enzymatic. Reference intervals were differentiated by sex and by age in 90% and 42%, respectively. Laboratories reported eGFR in 35% and only when requested in 13%. eGFR was calculated by the Modification of Diet in Renal Disease (MDRD) Study and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations in 88% and 12% of laboratories, respectively, and reporting was accompanied by information on the interpretation of values in 62%. Among nephrologists, 64% thought eGFR reporting useful, 29% were concerned with an excess of unnecessary requests for consultations and 95% expressed a favorable opinion of educational initiatives.
Our survey highlights the need for further improvement in serum creatinine measurement and reporting, and for coordinated interventions involving all major stakeholders.
用于血清肌酐测量的同位素稀释质谱法（IDMS）可溯源方法的扩散以及肾小球滤过率（eGFR）报告的相关数据十分有限。
向意大利伦巴第地区的认证实验室发放了一份调查问卷，其中包括以下问题：肌酐测量方法、仪器型号、IDMS 校准溯源性、按性别和年龄报告的参考区间、eGFR 报告、使用的 eGFR 公式以及患者记录中报告的 eGFR 值的相关信息。同时向肾脏病中心发放了一份平行问卷，其中包括以下问题：他们中心测量血清肌酐的方法、eGRF 报告的有用性以及对教育计划必要性的看法。
72 个实验室中的 72%和 47 个肾脏病中心中的 89%对问卷做出了回应。在用于测量血清肌酐的方法中，87%是 IDMS 可溯源的，30%是酶法。90%的实验室按性别区分参考区间，42%的实验室按年龄区分参考区间。35%的实验室报告 eGFR，只有 13%是应要求报告的。88%的实验室使用肾脏病饮食改良研究（MDRD）方程和慢性肾脏病流行病学合作（CKD-EPI）方程计算 eGFR，分别有 12%和 8%的实验室报告 eGFR，并在 62%的情况下报告值的解释信息。在肾脏病医生中，64%认为 eGFR 报告有用，29%担心过多不必要的咨询请求，95%对教育计划表示赞成。
我们的调查强调了需要进一步改进血清肌酐测量和报告，需要所有主要利益相关者共同参与协调干预。
