Choosing Wisely:

Don’t request just a serum creatinine to test adult patients with diabetes and/or hypertension for chronic kidney disease; use the kidney profile (serum creatinine with eGFR and urinary albumin-creatinine ratio.)

Rationale and Comments: Use the National Kidney Foundation updated evidence-based kidney profile test to evaluate patients for chronic kidney disease with the following common tests to more effectively assess kidney function.  “Spot” urine for albumin-creatinine ratio to detect albuminuria  Serum creatinine to estimate glomerular filtration rate using the Chronic Kidney Disease Epidemiology Collaboration equation
Sponsoring Organizations:
  • American Society for Clinical Pathology
  • Sources:
  • Expert consensus
  • Disciplines:
  • Nephrologic
  • References: • KDOQI US Commentary on the 2012 KDIGO clinical practice guideline for the evaluation and management of CKD. Am J Kidney Dis. 2014;63:713-735.
    • American Diabetes Association. 10. Microvascular Complications and Foot Care: Standards of Medical Care in Diabetes—2018. Diabetes Care. 2018;41(Suppl 1):S28-S37.
    • Vassalotti JA, Centor R, Turner BJ, et al. A practical approach to detection and management of chronic kidney disease for the primary care clinician. Am J Med. 2015;129:153-162.
    • Berns JS. Routine screening for CKD should be done in asymptomatic adults….selectively. Clin J Am Soc Nephrol. 2014;9:1988-1992.
    • Matsushita K, et al. Clinical risk implications of the CKD Epidemiology Collaboration (CKD-EPI) equation compared with the Modification of Diet in Renal Disease (MDRD) Study equation for estimated GFR. Am J Kidney Dis. 2010;60(2):241-249.
    • https://www.ascp.org/content/docs/default-source/get-involved-pdfs/istp-ckd/ckd-practice-algorithm.pdf

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