Awareness and Application of Creatinine Clearance/eGFR in Non-Nephrology Doctors

Introduction: We conducted this study to determine the awareness of usage of estimated GFR/creatinine clearance formulas while dealing with patients in various wards and outpatient departments of different tertiary hospitals in Lahore in doctors who are not working or trained in nephrology, it was done by using a questionnaire in between January 2019 to May 2019. It was found that good percentage of doctor is not using basic formulas and need education by fellow nephrology colleagues for basic patient management, drug dosing, and referral. Objective: To study the awareness and usage of creatinine clearance calculations in doctors not trained in nephrology. Study design: Descriptive, cross-sectional study. Methodology: The cross-sectional observational study was conducted. A questionnaire was designed which included questions about knowledge of estimated GFR/creatinine clearance, calculation methods, use of these formulas while dealing with patients for defining and diagnosing AKI and CKD, medicine dosage adjustment according to creatinine clearance and referral to nephrologists. Results: A total of 170 doctors working in different specialties were contacted and all of them filled questionnaire. 56 (32.9%) doctors answered that they know and calculate eGFR in routine practice while 114 (67.1%) were not performing eGFR while encountering patients. 80 (47.1%) were confident in staging chronic kidney disease and 90 (52.9%) were unable to stage chronic kidney disease on basis of eGFR. In routine patients dose and adjustment according to GFR was documented by 39 (22.9%) doctors and 131 (77.1%) doctors were not practicing dose adjustments for different medicines after calculating GFR. Referral to nephrologist was being done 99 (58.2%) doctors and 71 (41.8%) were not referring patients to nephrologists. Conclusion: Several considerable challenges remain regarding CKD and AKI early diagnosis and management and referral in Pakistan including inadequate knowledge and training systems, and needs education in this regard.

Diagnosis and screening of chronic kidney disease / 대한내과학회지

A simple definition of chronic kidney disease (CKD) is necessary to establish clinical practical guidelines. The Kidney Disease Outcomes Quality Initiative (K/DOQI) defined CKD as kidney damage or a glomerular filtration rate (GFR) 30 mg/g in two of three spot urine collections. With the CKD guidelines of K/DOQI and KDIGO, the diagnosis and early detection of CKD, which may need a Korean estimation equation, are improving and should help to reduce the prevalence and incidence of end-stage renal disease in Korea.

Evaluation of Residual Renal Function of Chronic Renal Failure at the Initiation of Dialysis / 대한신장학회잡지

The decision to initiate dialysis in a patient with progressive renal disease often depends on the physician's assessment of the patient's subjective symptoms of uremia. Decreased residual renal function and malnutrition at the initiation of dialysis is a strong predictor of subsequent increased relative risk of death on dialysis. In this context, to investigate the residual renal function and nutritional parameters of chronic renal failure patients at the initiation of dialysis, 103 patients with chronic renal failure patients were studied. The residual renal function(estimated GFR) was ascertained by measuring simultaneously the 24-h creatinine and urea clearances and averaging the two values and Krt/V. Nutritional parameters were ascertained by measuring the nPNA, %LBM and serum albumin. The mean estimated GFR was 5.97+/-2.88ml/min, the mean weekly Krt/V was 1.24+/-0.80, the mean %LBM was 61.66+/-22.41 and the mean nPNA was 0.89+/-0.30 g/day/kg. We knew that the time of initiation of dialysis, which was based on the manifestation of symptoms of certain patients in conjunction with selected laboratories indices, was delayed than that of NKF- DOQI recommendation. This study suggests that the timely initiation of dialysis is determined by not clinical symptoms and signs but estimated GFR, krt/V and nPNA.