Laboratory diagnosis of chronic kidney disease in adults: an overview of hospitals inserted in the Portuguese National Health System

Costa, Natália R.; Carvalho, Ana R. M.; Pinto, Carla M. A.; Andriolo, Adagmar; Guerra, Isabel C.

doi:10.5935/1676-2444.20170062

Natália R. Costa

Hospital de Pedro Hispano, Porto, Portugal.

Ana R. M. Carvalho

Universidade do Porto, Porto, Portugal.

Carla M. A. Pinto

Universidade do Porto, Porto, Portugal.

Adagmar Andriolo

Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil.

Isabel C. Guerra CORRESPONDING AUTHOR Isabel C. Guerra. e-mail: cachapuz.isabel@gmail.com.

Hospital de Pedro Hispano, Porto, Portugal.

CORRESPONDING AUTHOR Isabel C. Guerra. e-mail: cachapuz.isabel@gmail.com.

CONFLICTS OF INTEREST

We have no conflict of interest to declare.

Figures (7)
Tables (1)

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Figure 1
Laboratory methods for serum creatinine measurement

IDMS: isotope dilution mass spectrometry.

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Figure 2
eGFR reporting

eGFR: estimated glomerular filtration rate.

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Figure 3
eGFR measuring formulas

eGFR: estimated glomerular filtration rate; MDRD-4: Modification of Diet in Renal Disease version 4; MDRD-6: Modification of Diet in Renal Disease version 6; CKD-EPI: chronic kidney disease-epidemiology collaboration.

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Figure 4
Recommended sample to measure whole protein in urine

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Figure 5
Laboratory methods for total proteins measurement

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Figure 6
Recommended samples to measure albumin in the urine

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Figure 7
Laboratory methods to measure albumin in the urine

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Questions Answers Serum creatinine 1) Does your laboratory measure serum creatinine? • Yes (go to the next question)• No (go to question no. 17) 2) Please indicate the method used to measure serum creatinine values (more than one can be selected). • Not compensated Jaffe• Compensated Jaffe, IDMS calibrated• Compensated enzymatic method, calibration to IDMS• Dry chemistry• Other(s) (please specify) 3) Please specify the reagent's manufacturer(s) to measure serum creatinine. 4) Please specify the type of instrument(s) in which serum creatinine is measured. 5) In which unities of values the serum creatinine for adults (> 18 years old) are reported? • mg/dl• µmol/l• both 6) How many decimal places are presented in the creatinine results? • One• Two• More (please specify) 7) Which is the reference interval used by your laboratory for serum creatinine in adults? eGFR 8) Does your laboratory report the eGFR along with the determinants of serum creatinine? • Yes, along with serum creatinine measurement (go to question no. 11)• Yes, whenever ordered by the physician (go to question no. 11)• No (go to question no. 10 and afterwards to question no. 17) 9) Does your laboratory consider reporting the eGFR? • Yes• No 10) Which equations/formulas does your laboratory use to determine the eGFR? • MDRD-4 for non-standardized creatinine• MDRD-4 for standardized creatinine• MDRD-6• CKD-EPI• Cockroft-Gault• Other (please specify) 11) At what value does your laboratory point to an eGFR value higher than (>)? • 60 ml/min/1.73 m2• 90 ml/min/1.73 m2• Never. We always report the exact value• Other (please specify) 12) How does your laboratory report the results concerning the parameter "race"? • Two results, "Black" and "White"• Race evaluated during the appointment• Patient is asked to report its race• "Race" parameter is not included• Other (please specify) 13) In the eGFR result, there are included observations about possible variations of this value with: • Nutritional status• Pregnancy• Admitted patients• We don't include observations about possible variations of eGFR• Other(s) (please specify) 14) Special situations: admitted patients. • We report eGFR for admitted patients• We don't report eGFR for admitted patients 15) Which equations/formulas does your laboratory use to determine the eGFR in children? • Schwartz equation (original)• Schwartz equation (modified)• Other (please specify)• We don't calculate eGFR for children Urine protein and albumin 16) Do you perform the following tests in your laboratory? • Total protein in urine• Total albumin in urine• None of those (go to question no. 31) 17) Which is the recommended sample to measure total protein in urine? • 24-hour urine sample• Random urine sample• First morning urine• Not specified• Other (please specify) 18) Which method does your laboratory use to measure total protein in urine? • Nephelometry• Turbidimetry• Colorimetry• Dry chemistry• Other (please specify) 19) Please specify the reagent's manufacturer(s) to measure total protein in urine. 20) Please specify the type of instrument(s) in which total protein in urine is measured. 21) How the values of total protein in urine are reported? (More than one option can be selected) • mg/mmol creatinine• mg/g creatinine• g/24 h• g/l 22) Which is the reference interval for total protein in urine in your laboratory? 23) Which is the recommended sample to measure albumin in urine? • 24-hour urine sample• Random urine sample• First morning urine• Not specified• Other (please specify) 24) Which method does your laboratory use to measure albumin in urine? • Nephelometry• Turbidimetry• Colorimetry• Dry chemistry• Other (please specify) 25) Please specify the reagent's manufacturer(s) to measure albumin in urine. 26) Please specify the type of instrument(s) in which albumin in urine is measured. 27) How the values of albumin in urine are reported? (More than one option can be selected) • mg/mmol creatinine• mg/g creatinine• µg/min• mg/24 h• µg/ml• mg/l 28) Which is the reference interval for albumin in urine in your laboratory? 29) Does your laboratory report the ACR? • Yes• No Quality control 30) Concerning the parameters "serum creatinine", "total protein in urine" and "albumin in urine", which quality control program do you use? • "Serum creatinine" - IQC• "Serum creatinine" - EQC• "Urine protein" - IQC• "Urine protein" - EQC• "Urine albumin" - IQC• "Urine albumin" - EQC Education 31) Are you interested in obtaining information for the implementation of clinical guidelines to use in laboratory daily tasks, concerning the parameters referred in this survey? • Yes• No Confidentiality 32) Do you have any restriction to the divulgation of any of these data? • No• Yes, I don't want any of these data to be released• Yes, I don't want the information of some of the questions to be released (please specify) IDMS: isotope dilution mass spectrometry; eGFR: estimated glomerular filtration rate; MDRD-4: Modification of Diet in Renal Disease version 4; MDRD-6: Modification of Diet in Renal Disease version 6; CKD-EPI: chronic kidney disease-epidemiology collaboration; ACR: albumin/creatinine ratio; IQC: internal quality control; EQC: external quality control.

Questions	Answers
Serum creatinine
1) Does your laboratory measure serum creatinine?	• Yes (go to the next question) • No (go to question no. 17)
2) Please indicate the method used to measure serum creatinine values (more than one can be selected).	• Not compensated Jaffe • Compensated Jaffe, IDMS calibrated • Compensated enzymatic method, calibration to IDMS • Dry chemistry • Other(s) (please specify)
3) Please specify the reagent's manufacturer(s) to measure serum creatinine.
4) Please specify the type of instrument(s) in which serum creatinine is measured.
5) In which unities of values the serum creatinine for adults (> 18 years old) are reported?	• mg/dl • µmol/l • both
6) How many decimal places are presented in the creatinine results?	• One • Two • More (please specify)
7) Which is the reference interval used by your laboratory for serum creatinine in adults?
eGFR
8) Does your laboratory report the eGFR along with the determinants of serum creatinine?	• Yes, along with serum creatinine measurement (go to question no. 11) • Yes, whenever ordered by the physician (go to question no. 11) • No (go to question no. 10 and afterwards to question no. 17)
9) Does your laboratory consider reporting the eGFR?	• Yes • No
10) Which equations/formulas does your laboratory use to determine the eGFR?	• MDRD-4 for non-standardized creatinine • MDRD-4 for standardized creatinine • MDRD-6 • CKD-EPI • Cockroft-Gault • Other (please specify)
11) At what value does your laboratory point to an eGFR value higher than (>)?	• 60 ml/min/1.73 m² • 90 ml/min/1.73 m² • Never. We always report the exact value • Other (please specify)
12) How does your laboratory report the results concerning the parameter "race"?	• Two results, "Black" and "White" • Race evaluated during the appointment • Patient is asked to report its race • "Race" parameter is not included • Other (please specify)
13) In the eGFR result, there are included observations about possible variations of this value with:	• Nutritional status • Pregnancy • Admitted patients • We don't include observations about possible variations of eGFR • Other(s) (please specify)
14) Special situations: admitted patients.	• We report eGFR for admitted patients • We don't report eGFR for admitted patients
15) Which equations/formulas does your laboratory use to determine the eGFR in children?	• Schwartz equation (original) • Schwartz equation (modified) • Other (please specify) • We don't calculate eGFR for children
Urine protein and albumin
16) Do you perform the following tests in your laboratory?	• Total protein in urine • Total albumin in urine • None of those (go to question no. 31)
17) Which is the recommended sample to measure total protein in urine?	• 24-hour urine sample • Random urine sample • First morning urine • Not specified • Other (please specify)
18) Which method does your laboratory use to measure total protein in urine?	• Nephelometry • Turbidimetry • Colorimetry • Dry chemistry • Other (please specify)
19) Please specify the reagent's manufacturer(s) to measure total protein in urine.
20) Please specify the type of instrument(s) in which total protein in urine is measured.
21) How the values of total protein in urine are reported? (More than one option can be selected)	• mg/mmol creatinine • mg/g creatinine • g/24 h • g/l
22) Which is the reference interval for total protein in urine in your laboratory?
23) Which is the recommended sample to measure albumin in urine?	• 24-hour urine sample • Random urine sample • First morning urine • Not specified • Other (please specify)
24) Which method does your laboratory use to measure albumin in urine?	• Nephelometry • Turbidimetry • Colorimetry • Dry chemistry • Other (please specify)
25) Please specify the reagent's manufacturer(s) to measure albumin in urine.
26) Please specify the type of instrument(s) in which albumin in urine is measured.
27) How the values of albumin in urine are reported? (More than one option can be selected)	• mg/mmol creatinine • mg/g creatinine • µg/min • mg/24 h • µg/ml • mg/l
28) Which is the reference interval for albumin in urine in your laboratory?
29) Does your laboratory report the ACR?	• Yes • No
Quality control
30) Concerning the parameters "serum creatinine", "total protein in urine" and "albumin in urine", which quality control program do you use?	• "Serum creatinine" - IQC • "Serum creatinine" - EQC • "Urine protein" - IQC • "Urine protein" - EQC • "Urine albumin" - IQC • "Urine albumin" - EQC
Education
31) Are you interested in obtaining information for the implementation of clinical guidelines to use in laboratory daily tasks, concerning the parameters referred in this survey?	• Yes • No
Confidentiality
32) Do you have any restriction to the divulgation of any of these data?	• No • Yes, I don't want any of these data to be released • Yes, I don't want the information of some of the questions to be released (please specify)

[TFN1] IDMS: isotope dilution mass spectrometry; eGFR: estimated glomerular filtration rate; MDRD-4: Modification of Diet in Renal Disease version 4; MDRD-6: Modification of Diet in Renal Disease version 6; CKD-EPI: chronic kidney disease-epidemiology collaboration; ACR: albumin/creatinine ratio; IQC: internal quality control; EQC: external quality control.

Laboratory diagnosis of chronic kidney disease in adults: an overview of hospitals inserted in the Portuguese National Health System

Diagnóstico laboratorial de doença renal crônica em adultos: visão geral dos hospitais inseridos no Sistema Nacional de Saúde de Portugal

ABSTRACT