Part II Implementation of eGFR

1
Part II Implementation of eGFR The first batch
of questions sought to ascertain how many, when,
and using what formulae, laboratories had
implemented the reporting of eGFR. Of the
laboratories that responded 14/17 had already
implemented automatic reporting of eGFR. Of the
three that had not, all cited IT issues as a
reason for failure to implement, combined with
certain cost issues. Two of these three said that
implementation was pending but the third gave no
such indication and gave under-funding of GP
access work as a reason. Of those laboratories
that had implemented , one had done so back in
November 2004 and another in October 2005 but for
the majority (9/14) implementation had been
within a 3-4 week interval around 1/4/06, with
the remaining three implementing in May and June.
The auspicious date of 6/6/6 had been chosen by
one laboratory and one of the three not yet
reporting planned to do so from 30/6/06. Of the
15 sites already implementing (or about to) all
but one were using the 4 variable MDRD
calculation, and the other apparently a 3
variable (a typo?) 11/15 were using 175 as the
constant in the formula and 4/15 were using 186.
The use of constant was not linked to the
creatinine methodology employed but was linked to
the use of method specific slope and intercept
adjustments with all four respondents using the
186 factor replying that they did not use such
adjustments. Two of this group indicated that the
use of this factor was under review and, in one
case, going to change with the introduction of
new analysers. All but one (who gave no reply to
the question) of the remainder do use slope and
intercept adjustments. Next we sought to
determine reporting criteria, e.g. what was
reported, to whom and what interpretation was
provided. Only 3/15 (these replies include the
laboratory about to start reporting) calculate
and report eGFR on all creatinine requests.
Various exclusions were employed by the
remainder. Seven labs were reporting on all adult
(i.e. patients aged 18 or over) samples,
irrespective of the origin of the request. Four
were not reporting on most inpatients two were
only reporting on GP and OP patients, one on GP
and G.U.M. patients and one on GP and renal unit
patients. For one respondent the excluding factor
appears not to be the source of the request but
the result, with only eGFRs of lt60 reported.
With respect to reporting criteria according to
results once again only 3/15 report all results
as calculated, two only report values if they are
less than 60, the remaining ten laboratories
report all values less than 90 but report those
higher than 90 just as gt90. All laboratories
report eGFR alongside the routine UE results,
but only five report the CKD stage with the eGFR
calculation, whilst 9/15 provide a multiplication
factor to applied for African-Caribbean patients.
We asked what other interpretative comments
were issued on reports. If repetition of answers
to previous questions is excluded, 4/15 offer no
further interpretation 3/15 have issued
requesters with detailed guidance/guidelines and
so provide no interpretation on reports. Two
laboratories provide a hyperlink to renal
physicians intranet/websites whilst two initially
no longer provided comments but no longer does,
one now gives only the www.renal.org address on
reports and the other the African-Caribbean
multiplication factor. The remaining five
laboratories give varying degrees of
interpretation, from single catch-all comments
regarding exclusions, CKD stage, referral
criteria etc. to tailored comments generated
automatically and based on the result. At least
three of these also include the renal.org address
in their comments. According to the answers
provided only four laboratories specifically
comment on the groups for whom eGFR is not
recommended. 5/15 respondents told us that they
had NOT agreed referral criteria with their local
renal physicians. All but one laboratory
participates in an appropriate EQA scheme with
five belonging to both UKNEQAS and WEQAS schemes.
Finally we asked about charging for eGFR
calculation/reporting Only one laboratory is
currently charging (1) for eGFR but the one
introducing it on 30/6 will also be charging 1,
four more are planning to charge or thinking
about it and the remaining nine do not charge.
Charging for eGFR does not seem linked to
Foundation Trust status.