External Proficiency Testing in Canada - IFCC

IFCC Workshop

TF-CKD

Kuala Lumpur

November 19, 2012

Members IFCC TF-CKD

Graham JONES

Edmund LAMB (UK)

David SECCOMBE (Canada)

Joe CORESH (USA)

Andrew NARVA (USA)

Mauro PANTEGHINI (Italy)

Joris DELANGHE (Belgium)

John H. Eckfeldt (USA)*

Adagmar ANDRIOLO (Brazil)*

* WASPaLM nominees

(World Association of Societies of Pathology

and Laboratory Medicine )

End-Stage Renal Disease

Country/Geography Incidence

Europe 135 per million population

United Kingdom 101

United States 336

Latin America 400

Kidney Disease

80% of those with kidney disease don’t even know they

have it

76% of patients on first referral to a nephrologist already

have Stage 4 disease

Annual cost of end-stage renal disease in the US $16.7

billion (2000); projected to grow to $39.3 billion by 2010

Mexico City - Screening Program

Over 20% have CKD

Obrador GT. KEEP Study. Kidney Int Suppl. 2010 Mar;(116):S2-8.

Japan – Screening Program

25% CKD (average age 59)

Kidney International 77, S17-S23 (March 2010)

Iran Taxi Drivers – Screening program

6% have CKD (average age 43)

Mahdavi-Mazdeh, M. Renal Failure 2010;32: 62-68

South Korea – Population study

Over 6% have CKD

KNHANES. Shin Yi Jang et al

CKD and Cardiovascular Risk

Anavekar N et al, NEJM 2004; 35: 1285-1295

CKD and Diabetes

USA data

40% of diabetics have CKD

17% of pre-diabetics have CKD

< 10% of diabetic patients are even screened for kidney

disease

Rationale

Kidney failure is a global public health problem which is

increasing in magnitude

Economical, effective testing and treatment exist

Testing and therapy are inadequately applied

The goal is to identify, prevent and/or treat CKD at an

earlier stage to prevent progression of the disease

Why the Lab?

Laboratories serve as the “hub” for information flow

within a health care system

Laboratory test results trigger medical decisions. All

doctors communicate regularly with the lab

Laboratories are the best vehicle for disseminating

standardized tests and health care messaging throughout a

health care system

Clinical Guidelines for Chronic Kidney Disease

(NKF)

Clinical Guidelines for Chronic Kidney

Disease (NKF)

GFR should be estimated from prediction equations

Serum creatinine alone should not be used to assess the level of kidney function

Clinical laboratories should report an estimate of GFR

Measurement of creatinine clearance using timed urine collections does not improve the estimation of GFR

(AM J Kidney Dis 37 (suppl 1):S182-S238, 2002)

Modification of Diet in Renal Disease

(MDRD)

Requires – age, gender, serum creatinine

Reporting units - mL/min/1.73m2

Proven to be more accurate and precise than other

formulae (+/- 30%)

(Levey et al. Ann Intern Med 130:461- 470, 1999)

Creatinine Standardization

Reference Method

Isotope Dilution Mass Spectrometry (IDMS)

Reference Materials

NIST SRM 914 (pure creatinine)

NIST SRM 967 (commutable)

Traceability

“Laboratories are the best vehicle for

implementing a national program for the

early detection of CKD”

What is required for a national CKD

laboratory program?

All labs need to report eGFR for earlier identification of CKD

Laboratory tests that are critical for the diagnosis and management

of CKD need to be standardized

eGFR reporting comments need to be standardized throughout for

unified messaging on CKD

Communication strategies and CKD/eGFR educational materials

are needed for the laboratory, physicians and the public

“Laboratory Task force on the prevention of

chronic kidney disease in Mexico”

• Federación Mexicana de Patología Clínica

(FeMPaC/WASPaLM)

• Asociación Mexicana de Bioquímica Clínica (AMBC/IFCC)

• Confederación Nacional de Químicos Clínico (CONAQUIC)

• Asociación Nacional de Nefrólogos de México (ANNM)

• Instituto Mexicano de Investigaciones Nefrológicas (IMIN)

Mission/Misión

Preventing chronic diseases in Mexico by standardizing

laboratory tests to improve the health of all people

Prevenir las enfermedades crónicas

en México mediante la estandarización

de las pruebas de laboratorio para mejorar la

salud de toda la población

Consejo científico

Enfermedad

renal crónica

• CONAQUIC

• AMBC

• FEMPAC

• ANNMAC

• IMIN

Enfermedades

Cardiovasculares

Diabetes

“You can make a difference”

David W Seccombe MD, PhD, FRCPC

Department of Pathology and Laboratory Medicine

University of British Columbia, Vancouver BC

[email protected]