We recommend that serum creatinine concentration be reported and rounded to the nearest whole number when expressed as standard international units (mmol/L) and rounded to the nearest 100th of a whole number when expressed as conventional units (mg/dL). Report eGFRcreat in adults using the 2021 CKD-EPI creatinine equation. Report eGFRcreat in addition to the serum creatinine concentration in adults and specify the equation used whenever reporting eGFRcreat. Measure serum creatinine using a specific assay with calibration traceable to the international standard reference materials and minimal bias compared to isotope-dilution mass spectrometry (IDMS) reference methodology. 1.4.3.4: We recommend that clinical laboratories should: Understand clinical settings in which eGFR creat is less accurate. Use a GFR estimating equation to derive GFR from serum creatinine (eGFRcreat) rather than relying on the serum creatinine concentration alone.
1.4.3.2: We suggest using additional tests (such as cystatin C or a clearance measurement) for confirmatory testing in specific circumstances when eGFR based on serum creatinine is less accurate.
1.4.3.1: We recommend using serum creatinine and GFR estimating equation for initial assessment. The Kidney Disease: Improving Global Outcomes (KDIGO) CKD work group clinical practice guidelines,(1) as further defined by the National Kidney Foundation-Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) commentary,(2) provided recommendations for reporting and interpretation of serum creatinine and eGFR, which were revised after development of a refit CKD-EPI Creatinine eGFR equation in 2021 that does not require a mathematical adjustment based on race: The new 2021 CKD-EPI eGFR values cannot be directly compared to the previous 2009 CKD-EPI Cr eGFR values, which were separately reported for African American and non-African American populations. The 2021 CKD-EPI Cr equation does not require race, so eGFR values for both African American and non-African American populations are no longer reported. Unlike the Cockcroft-Gault equation, height and weight, which are often not available in the laboratory information system, are not required. From a serum creatinine measurement, it generates a GFR result normalized to a standard body surface area (1.73 m) using sex and age. The CKD-EPI equation does not require weight or height variables. Estimated GFR is a more practical means to closely follow changes in GFR over time, when compared to direct measurement using methods such as iothalamate clearance. Monitoring kidney function (by GFR or creatinine clearance) is essential once albuminuria is discovered. Therefore, if a depressed eGFR is calculated from a serum creatinine measurement, it may help providers recognize early CKD and pursue appropriate follow-up testing and therapeutic intervention. However, there is poor adherence to guidelines that suggest annual urinary albumin testing of patients with known diabetes. Albuminuria (>30 mg/24 hour or urine albumin to creatinine ratio >30 mg/g) may be a more sensitive marker of early kidney disease, especially among patients with diabetic nephropathy. Creatinine is commonly measured in routine clinical practice. The effects of age and sex further cloud interpretation. GFR and creatinine clearance are inversely and nonlinearly related to serum creatinine. GFR and creatinine clearance are poorly inferred from serum creatinine alone. Reasons given for routine reporting of eGFR with every serum creatinine in adult (18 and over) patients include: Use of an estimating or prediction equation to estimate GFR from serum creatinine should be employed for people with CKD and those with risk factors for CKD (diabetes, hypertension, cardiovascular disease, and family history of kidney disease). alpha is -0.241 for females and -0.302 for males Estimated glomerular filtration rate (eGFR) using serum creatinine alone is calculated using the 2021 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation:ĮGFR = 142 x min(standardized Scr/k,1)alpha x max(Scr/k, 1)-1.200 x (0.9938 x age) x 1.012 (if patient is female)
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