Kidney Week

Abstract: TH-OR49

Barriers and Opportunities to Improve Variability in CKD Laboratory Methodology and Reporting: Results from the College of American Pathologists (CAP) 2019 Survey

Session Information

• Pathology of Kidney Diseases: Novel Mechanisms and Clinical Correlations
  October 22, 2020 | Location: Simulive
  Abstract Time: 05:00 PM - 07:00 PM

Category: Pathology and Lab Medicine

• 1602 Pathology and Lab Medicine: Clinical

Authors

• Vassalotti, Joseph A., Icahn School of Medicine at Mount Sinai, New York, New York, United States

Joseph A. Vassalotti, MD, FASN

Dr. Joseph Vassalotti is the Chief Medical Officer of the National Kidney Foundation and Clinical Professor of Medicine in the Division of Nephrology at Icahn School of Medicine at Mount Sinai. Addressing chronic kidney disease (CKD) gaps in care in the U.S. through awareness, public health and quality improvement initiatives is the major focus. He has served on numerous committees that shape innovation and health policy in kidney disease for the CDC, the NIH and CMS. Currently, he serves as Principal Investigator for the Kidney Score Platform an NKF educational project funded by the Veterans Administration Center for Innovation to improve awareness and education among Veterans with and at risk for CKD in the primary care setting. He also serves as PI for an AARP-funded OptumLabs Data Warehouse investigation that evaluates disparities in the Kidney Health Evaluation Measure for CKD testing of Americans with diabetes as well as analyzes CKD detection and evidenced-based therapies driven by the measure. Dr. Vassalotti typically sees approximately 40 patients per week and has over 100 publications in peer-reviewed journals.

• Miller, Greg, Virginia Commonwealth University, Richmond, Virginia, United States

Greg Miller,

Background

Variability in laboratory practices for estimated GFR (eGFR) and urine albumin-creatinine ratio (uACR) is a barrier to optimal CKD testing and interpretation by clinicians. The CAP serial surveys assess CKD laboratory methodology and reporting.

Methods

The CAP 2019 General Chemistry Survey conducted in December, included 9 questions regarding CKD tests.

Results

Respondents included 7,105 laboratories (83.8% U.S. and 16.2% international) with a response rate of 87.5%. Laboratory reporting of eGFR based on serum creatinine has increased overall from 3% to 92% in CAP surveys between 2003 and 2019. The Figure shows 76% of laboratories were using an isotope dilution mass spectrometry (IDMS) traceable version of the MDRD 4-variable equation (45%) or the CKD-EPI equation (31%), but an incorrect equation was used for IDMS creatinine by 23% of the respondents, resulting in systematic over estimation of kidney function. Barriers for the pediatric population less than 18 years include only 10% of laboratories report the correct bedside Schwartz equation and 20% of laboratories applied an incorrect adult eGFR equation for children. The microalbumin term that KDIGO and KDOQI recommend be eliminated continues to be used by 64.5% of U.S. and 42.2% of international labs, see Table. Lastly, 12.6% of U.S., and 9.4% of international laboratories report only the urine albumin concentration without uACR, which is uniformly not recommended.

Conclusion

Laboratory variability is a call to action for nephrologists to collaborate with clinical laboratorians to improve appropriate CKD testing.

eGFR Equation Reporting

Albuminuria Reproting