IFCC Workshop TF-CKD Kuala Lumpur November 19, 2012
Members IFCC TF-CKD Graham JONES Edmund LAMB (UK) David SECCOMBE (Canada) Joe CORESH (USA) Andrew NARVA (USA) Mauro PANTEGHINI (Italy) Joris DELANGHE (Belgium) John H. Eckfeldt (USA)* Adagmar ANDRIOLO (Brazil)* * WASPaLM nominees (World Association of Societies of Pathology and Laboratory Medicine )
End-Stage Renal Disease Country/Geography Europe Incidence 135 per million population United Kingdom 101 United States 336 Latin America 400
Kidney Disease 80% of those with kidney disease don t even know they have it 76% of patients on first referral to a nephrologist already have Stage 4 disease Annual cost of end-stage renal disease in the US $16.7 billion (2000); projected to grow to $39.3 billion by 2010
Mexico City - Screening Program Over 20% have CKD Obrador GT. KEEP Study. Kidney Int Suppl. 2010 Mar;(116):S2-8. Japan Screening Program 25% CKD (average age 59) Kidney International 77, S17-S23 (March 2010) Iran Taxi Drivers Screening program 6% have CKD (average age 43) Mahdavi-Mazdeh, M. Renal Failure 2010;32: 62-68 South Korea Population study Over 6% have CKD KNHANES. Shin Yi Jang et al
CKD and Cardiovascular Risk Anavekar N et al, NEJM 2004; 35: 1285-1295
CKD and Diabetes USA data 40% of diabetics have CKD 17% of pre-diabetics have CKD < 10% of diabetic patients are even screened for kidney disease
Rationale Kidney failure is a global public health problem which is increasing in magnitude Economical, effective testing and treatment exist Testing and therapy are inadequately applied The goal is to identify, prevent and/or treat CKD at an earlier stage to prevent progression of the disease
Why the Lab? Laboratories serve as the hub for information flow within a health care system Laboratory test results trigger medical decisions. All doctors communicate regularly with the lab Laboratories are the best vehicle for disseminating standardized tests and health care messaging throughout a health care system
Clinical Guidelines for Chronic Kidney Disease (NKF)
Clinical Guidelines for Chronic Kidney Disease (NKF) GFR should be estimated from prediction equations Serum creatinine alone should not be used to assess the level of kidney function Clinical laboratories should report an estimate of GFR Measurement of creatinine clearance using timed urine collections does not improve the estimation of GFR (AM J Kidney Dis 37 (suppl 1):S182-S238, 2002)
Modification of Diet in Renal Disease (MDRD) Requires age, gender, serum creatinine Reporting units - ml/min/1.73m 2 Proven to be more accurate and precise than other formulae (+/- 30%) (Levey et al. Ann Intern Med 130:461-470, 1999)
Creatinine Standardization Reference Method Isotope Dilution Mass Spectrometry (IDMS) Reference Materials NIST SRM 914 (pure creatinine) NIST SRM 967 (commutable)
Traceability
Laboratories are the best vehicle for implementing a national program for the early detection of CKD
What is required for a national CKD laboratory program?
All labs need to report egfr for earlier identification of CKD Laboratory tests that are critical for the diagnosis and management of CKD need to be standardized egfr reporting comments need to be standardized throughout for unified messaging on CKD Communication strategies and CKD/eGFR educational materials are needed for the laboratory, physicians and the public
Laboratory Task force on the prevention of chronic kidney disease in Mexico Federación Mexicana de Patología Clínica (FeMPaC/WASPaLM) Asociación Mexicana de Bioquímica Clínica (AMBC/IFCC) Confederación Nacional de Químicos Clínico (CONAQUIC) Asociación Nacional de Nefrólogos de México (ANNM) Instituto Mexicano de Investigaciones Nefrológicas (IMIN)
Mission/Misión Preventing chronic diseases in Mexico by standardizing laboratory tests to improve the health of all people Prevenir las enfermedades crónicas en México mediante la estandarización de las pruebas de laboratorio para mejorar la salud de toda la población
Consejo científico Enfermedad renal crónica Diabetes Enfermedades Cardiovasculares CONAQUIC AMBC FEMPAC ANNMAC IMIN
You can make a difference
David W Seccombe MD, PhD, FRCPC Department of Pathology and Laboratory Medicine University of British Columbia, Vancouver BC dseccombe@ceqal.com