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Press Start: Lead an Empowered Life as a Clinical Laboratorian

The Laboratory’s Expanded Role in Managing Kidney Disease

Published February 22, 2015 4:30 PM by Glen McDaniel

Kidney disease is one of the most significant chronic ailments affecting Americans. Renal disease is often a sequela of one of several maladies that plague Americans: diabetes, hypertension, glomerulonephritis, autoimmune disease, polycystic kidney disease and others.

 

An estimated 20 million Americans have chronic kidney disease (CKD) some managed by diet, exercise and medication alone, while others need regular dialysis.

 

Quality of life can be adversely affected and impacted by kidney disease.

 

The laboratory plays a crucial role in the diagnosis and treatment of renal disease. One of the ongoing challenges for providers is the variation in tests performed by different laboratories on different platforms using different reagents.  There have been several attempts to create harmonization to standardize results and make it easier to interpret results from various labs and even from visit to visit.

 

In late 2012 some guidelines called the Kidney Disease Improving Global Outcomes (KDIGO) Clinical Practice Guidelines for the Evaluation and Management of CKD were introduced.

 

These guidelines were developed  through the collaboration of many international experts and build significantly on lessons learned from previous guidelines. One very important aspect of this guideline is that it contains strong recommendations for laboratory input and involvement in the process of care. It only makes sense that the experts who provide the information used in decision making should understand the recommended best practices and the rationale for such practices.

 

Not surprisingly, laboratory involvement will require a more active participation, rather than the typical passive behind the scenes “just do what the doctor orders” traditional approach.

 

Among the “Key Factors for Laboratorians” required by the 2012 KDIGO Guideline are the following

 

-Ensure good communication between laboratory professionals and relevant clinicians, such as nephrologists and primary care doctors.

-Aim for common laboratory practices in a region so patients receive the same care with comparable results from visit to visit, regardless of location where the testing is performed.

-Ensure creatinine results are aligned to an isotope dilution mass spectrometry standard (IDMS)

-Select an appropriate glomerular filtration Rate (GFR) formula for your population.

-Laboratories should use the same units, number of significant figures and clinical decision points for both serum creatinine and eGFR reporting.

-Laboratories should understand, and provide information on, their creatinine method, including any limitations and interpretation

-Laboratories should provide measurements of urine albumin and urine creatinine using traceable assays. These tests might be part of a periodic monitoring protocol in a high-risk population such as  known diabetics.

-Laboratories should provide Albumin/Creatinine ratio (ACR) and do so in a clear, consistent manner to help clinicians make correct decisions regarding declining renal function in any one patient from site to site and visit to visit.

 

All of these recommendations make good sense and offer yet another chance for the laboratory to be an active participant in patient care. This involvement should provide job enrichment as the laboratorian assumes a greater proactive and professional role. However, these are recommendations, not mandates.

 

 If laboratorians are hesitant and acquiescent then another player will step forward. Then once again, someone outside the laboratory, perhaps with limited knowledge of MLS, will direct “the lab” on what to do. It’s our choice, really.

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