Nigerian Postgraduate Medical Journal (Jan 2013)
Routine reporting of estimated glomerular filtration rate (eGFR) in African Laboratories and the need for its increased utilisation in Clinical Practice
Abstract
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 · (1.73 m2) [<1 mL– 1 · (1.73 m2)1 for three months or more. CKD is associated with poor outcomes and high cost, disproportionately affecting the elderly, the Black race and the middle aged in Nigeria. Thus, new public health campaigns focus on early detection of CKD. To facilitate early detection of CKD, many national and international organisations now recommend routine reporting of estimated glomerular filtration rate (eGFR) whenever serum creatinine is measured. The formulae/equations provide a quick estimate (eGFR) of the GFR without need for urine collection in clinical practice. Current guidelines advocate the use of prediction equations, such as the Cockcroft-Gault (CG) formula and the Modification of Diet in Renal Disease (MDRD) study-derived equations. Laboratories in African should commence routine reporting of eGFR for a number of reasons; 1. The sensitivity of serum creatinine (Scr) in identifying CKD is low.2. 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 officers.3 Studies have shown that routine reporting of eGFR improved the documentation and identification of CKD by almost 50%.4 There is the possibility of reversing CKD if picked earlier.5. The high cost of treating CKD patients in advanced stages and the low per capital income status of the populace in Sub-Saharan Africa.6. Poor health infrastructure to manage advanced CKD patients in the continent.7. Several studies, 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, non-linear relationship between GFR and serum creatinine).8 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.9 Recent guidelines define "action plans" for CKD according to the GFR, including referral to nephrologists at GFRs <30 mL · min– 1 · (1.73 m2).
