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Routine reporting of estimated glomerular filtration rate: not ready for prime time

Nature Clinical Practice Nephrology volume 4, pages 422–423 (2008)Cite this article

A worldwide movement is underway to oblige laboratories to provide an estimated glomerular filtration rate (eGFR) whenever serum creatinine concentration is measured at the request of a physician. We regard this development with concern. Such reporting constitutes de facto screening for chronic kidney disease (CKD), and the validity of eGFR for this purpose has not been appropriately tested.1,2 eGFR reporting is already mandatory in the UK and has been endorsed by several organizations in the US and Australasia.3,4 UK nephrologists and primary care physicians have experienced the negative effects of mandatory eGFR reporting. Nephrologists in other countries could well have similar experiences if this policy is universally adopted by hospital and commercial clinical laboratories.

In patients already diagnosed with CKD, eGFR (as calculated by the abbreviated Modification of Diet in Renal Disease [MDRD] equation5) might provide a less crude description of the degree of impairment in renal function than does a serum creatinine measurement alone, but this view is debatable.1,6 Knowledge of eGFR could also aid the selection of safe and effective dosing regimens for potentially toxic drugs that are eliminated largely by glomerular filtration, although the superiority of the MDRD-estimated eGFR over other estimates for this purpose is not well established.7 Undoubtedly, the concept of eGFR has raised the profile of CKD in the community at large. However, it was not anticipated that the MDRD equation, which was derived from patients with unequivocal kidney disease, would be used as a means for the diagnosis of kidney disease in patients with no a priori evidence of such disease. Herein lies the crux of our concern.

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Authors and Affiliations

  1. RJ Glassock is Professor Emeritus at the David Geffen School of Medicine at UCLA, Los Angeles, CA, USA, and,

    Richard J Glassock

  2. CG Winearls is Clinical Director of the Oxford Kidney Unit, Oxford, UK.,

    Christopher G Winearls

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  1. Richard J Glassock
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  2. Christopher G Winearls
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Correspondence to Richard J Glassock.

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Competing interests

RJ Glassock has declared associations with the following organizations: the American Society of Nephrology (editor of journal) and the National Kidney Foundation (speakers bureau honoraria). CG Winearls has declared no competing interests.

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Glassock, R., Winearls, C. Routine reporting of estimated glomerular filtration rate: not ready for prime time. Nat Rev Nephrol 4, 422–423 (2008). https://doi.org/10.1038/ncpneph0860

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