Orders for CrCl Testing Decreased after eGFR Reporting

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The introduction of estimated glomerular filtration rate (eGFR) reporting with prompts by outpatient laboratories has led to decreased physician requests for creatinine clearance (CrCl) testing in Ontario, reports Kidney International.

The study was designed to evaluate the 2006 introduction of eGFR reporting with prompts at outpatient laboratories in Ontario whenever a serum creatinine test was ordered. The change was implemented to improve recognition of chronic kidney disease. It also supported the 2002 Kidney Disease Outcomes/Quality Initiative (KDOQI) clinical practice guideline recommending the use of eGFR and discouraging timed urine collection for CrCl, except in specific situations. The effects of these interventions were analyzed using data on adult patients in Ontario from 1999 to 2009.

The KDOQI guideline had little or no effect on the monthly rate of CrCl collection: 42.3 versus 46.2 per 100,000 adult population. In contrast, after introduction of eGFR reporting with prompts, the rate of CrCl testing decreased from 44.6 to 34.1 per 100,000 adult population. This represented a “sudden and significant” 23.5 percent decrease over the 43-month period analyzed.

The study shows a significant reduction in the sex- and age-adjusted rate of CrCl testing after the introduction of routine eGFR reporting, whereas a clinical practice guideline alone had no significant effect. Laboratory reporting and other educational and structural changes may be more likely to achieve compliance with evidence-based guidelines [Kagoma YK, et al: Reporting of the estimated glomerular filtration rate decreased creatinine clearance testing. Kidney Int 2012; 81: 1245–1247].