Information and consensus document for the detection and management of chronic kidney disease.

Chronic kidney disease (CKD) is a major public health problem worldwide that affects more than 10% of the Spanish population. CKD is associated with high comorbidity rates, poor prognosis and major consumption of health system resources. Since the publication of the last consensus document on CKD seven years ago, little evidence has emerged and few clinical trials on new diagnostic and treatment strategies in CKD have been conducted, apart from new trials in diabetic kidney disease. Therefore, CKD international guidelines have not been recently updated. The rigidity and conservative attitude of the guidelines should not prevent the publication of updates in knowledge about certain matters that may be key in detecting CKD and managing patients with this disease. This document, also prepared by 10 scientific associations, provides an update on concepts, clarifications, diagnostic criteria, remission strategies and new treatment options. The evidence and the main studies published on these aspects of CKD have been reviewed. This should be considered more as an information document on CKD. It includes an update on CKD detection, risk factors and screening; a definition of renal progression; an update of remission criteria with new suggestions in the older population; CKD monitoring and prevention strategies; management of associated comorbidities, particularly in diabetes mellitus; roles of the Primary Care physician in CKD management; and what not to do in Nephrology. The aim of the document is to serve as an aid in the multidisciplinary management of the patient with CKD based on current recommendations and knowledge.

Tablas para la estimación del filtrado glomerular mediante la nueva ecuación CKD-EPI a partir de la concentración de creatinina sérica / Tables for estimating the glomerular filtration rate using the new CKD-EPI equation from serum creatinine concentration

La enfermedad renal crónica (ERC) y las complicaciones que de ella se derivan se han convertido en un importante problema sanitario, tanto por los recursos que se requieren en los estadios finales de la enfermedad como por las complicaciones secundarias que conlleva, por lo que su diagnóstico precoz es considerado hoy de gran importancia. Las guías KDIGO 2013 recientemente publicadas basan la definición y clasificación de la ERC en los valores de filtrado glomerular y albuminuria como criterios de estadiaje y marcadores pronóstico de la enfermedad. Las ecuaciones MDRD y MDRD-IDMS (cuando se utilizan valores de creatinina obtenidos por métodos con trazabilidad al método de referencia) son las más utilizadas, pero tanto las guías internacionales KDIGO 2013 como el nuevo documento de consenso sobre la ERC 2013, en el que han participado diez sociedades científicas bajo la dirección de la Sociedad Española de Nefrología, recomiendan su sustitución por la ecuación CKD-EPI. Nuestro objetivo ha sido, tal y como hicimos con ecuaciones previas, elaborar unas tablas que permitan conocer el valor del filtrado glomerular estimado mediante la ecuación CKD-EPI a partir de la concentración sérica de creatinina, la edad y el sexo, y de este modo proporcionar un instrumento que facilite la difusión de esta nueva ecuación, especialmente en ámbitos en los que no se calcule de modo automático (AU)

Chronic kidney disease (CKD) and its complications have become a major healthcare problem, both due to the resources that are required in the final stages of the disease and to secondary complications. As such, its early diagnosis is considered to be very important nowadays. The recently published 2013 KDIGO guidelines base the definition and classification of CKD on glomerular filtration values and albuminuria as staging criteria and prognostic markers of the disease. The MDRD and MDRD-IDMS equations (when creatinine values can be traced to the reference method) are those most used, but both the 2013 KDIGO international guidelines and the new 2013 CKD consensus document, in which ten scientific societies participated under the direction of the Spanish Society of Nephrology, recommend to be replaced by the CKD-EPI equation. Our objective has been, as with previous equations, to develop tables that display the estimated glomerular filtration rate value using the CKD-EPI equation from serum creatinine concentration, age and sex, and thereby provide an instrument that facilitates the dissemination of this new equation, particularly in settings where it is not calculated automatically (AU)

Tables for estimating the glomerular filtration rate using the new CKD-EPI equation from serum creatinine concentration.

Chronic kidney disease (CKD) and its complications have become a major healthcare problem, both due to the resources that are required in the final stages of the disease and to secondary complications. As such, its early diagnosis is considered to be very important nowadays. The recently published 2013 KDIGO guidelines base the definition and classification of CKD on glomerular filtration values and albuminuria as staging criteria and prognostic markers of the disease. The MDRD and MDRD-IDMS equations (when creatinine values can be traced to the reference method) are those most used, but both the 2013 KDIGO international guidelines and the new 2013 CKD consensus document, in which ten scientific societies participated under the direction of the Spanish Society of Nephrology, recommend to be replaced by the CKD-EPI equation. Our objective has been, as with previous equations, to develop tables that display the estimated glomerular filtration rate value using the CKD-EPI equation from serum creatinine concentration, age and sex, and thereby provide an instrument that facilitates the dissemination of this new equation, particularly in settings where it is not calculated automatically.

Current use of equations for estimating glomerular filtration rate in Spanish laboratories.

INTRODUCTION: In 2006 the Spanish Society of Clinical Biochemistry and Molecular Pathology (SEQC) and the Spanish Society of Nephrology (S.E.N.) developed a consensus document in order to facilitate the diagnosis and monitoring of chronic kidney disease with the incorporation of equations for estimating glomerular filtration rate (eGFR) into laboratory reports. The current national prevalence of eGFR reporting and the degree of adherence to these recommendations among clinical laboratories is unknown. METHODS: We administered a national survey in 2010-11 to Spanish clinical laboratories. The survey was through e-mail or telephone to laboratories that participated in the SEQC’s Programme for External Quality Assurance, included in the National Hospitals Catalogue 2010, including both primary care and private laboratories. RESULTS: A total of 281 laboratories answered to the survey. Of these, 88.2% reported on the eGFR, with 61.9% reporting on the MDRD equation and 31.6% using the MDRD-IDMS equation. A total of 42.5% of laboratories always reported serum creatinine values, and other variables only when specifically requested. Regarding the way results were presented, 46.2% of laboratories reported the exact numerical value only when the filtration rate was below 60mL/min/1.73m2, while 50.6% reported all values regardless. In 56.3% of the cases reporting eGFR, an interpretive commentary of it was enclosed. CONCLUSIONS: Although a high percentage of Spanish laboratories have added eGFR in their reports, this metric is not universally used. Moreover, some aspects, such as the equation used and the correct expression of eGFR results, should be improved.

Estandarización de los procedimientos de medida de creatinina: estado actual / Standardization of creatinine measurement methods: current status

La implementación de las ecuaciones de estimación del filtrado glomerular (FG) en los informes del laboratorio clínico ha colocado en el punto de mira las limitaciones de la medida de creatinina y promovido la puesta en marcha de un programa internacional para su estandarización. Hemos analizado el estado actual de implementación de dicho programa respecto a la trazabilidad, la conmutabilidad, la imprecisión, el error sistemático, así como la información acerca del tipo de ecuación a utilizar y sobre los valores de referencia, de los reactivos de creatinina más utilizados en los laboratorios españoles. La mayoría de los procedimientos de medida presentan trazabilidad al método de referencia y satisfacen los requerimientos de imprecisión; sin embargo, la información disponible sobre la inexactitud, el error total de medida, la verificación de la conmutabilidad de los materiales de calibración utilizados, la ecuación de FG a utilizar y los valores de referencia en población pediátrica es insuficiente o inexistente en la mayoría de las firmas comerciales evaluadas (AU)

The implementation of equations for estimating glomerular filtration rate (GFR) in clinical laboratory reports has placed the spotlight on the limitations of creatinine measurements and has promoted the establishment of an international program for standardisation. We have analysed the current state of implementation of this program with regard to traceability, commutability, imprecision, systematic error, as well as information on the type of equation to use and reference values, as well as the creatinine reagents commonly used in Spanish laboratories. Most of the measurement procedures have traceability to the reference method, and meet the requirements of imprecision. The available information available on the inaccuracy, the total error of measurement, verification of the commutability of calibration materials used, the glomerular filtration equation to use, and reference values in the paediatric population is unsatisfactory or non-existent in most commercial firms evaluated (AU)

Utilización de las ecuaciones de estimación del filtrado glomerular para el ajuste de dosis de fármacos / Use of estimated glomerular filtration formulas for dose adjustment

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[Changes in prostate specific antigen levels during intravesical instillations with Calmette-Guerin bacillus: relationship with transurethral resection of the prostate]. / Variación de los niveles de antígeno prostático específico durante las instilaciones endovesicales de bacilo de Calmette-Guerin: relación con la resección transuretral de próstata.

OBJECTIVES: To evaluate variations on the serum PSA levels during and after administration of intravesical BCG and its relationship with previous transurethral resection of the prostate (TURP). METHODS: PSA serum concentration variations were studied after each instillation, at 1 month and at 3 months in 24 patients with superficial bladder cancer and/or CIS under weekly BCG instillations treatment. Three patients had undergone TURP. RESULTS: A raise in PSA was observed in 87.5% of the cases during BCG instillations, although the increase was only significative in patients who had undergone TURP. PSA values descended at one and three months. CONCLUSIONS: Endovesical BCG administration produces an increase on serum PSA levels. This variation is higher in patients with history of TURP.

Variación de los niveles de antígeno prostático específico durante las instilaciones endovesicales de bacilo de Calmette-Guerin: relación con la resección transuretral de próstata / Variations on prostate specific antigen (PSA) during endovesical instillations with bacillus Calmette-Guerin: relationship with transurethral resection of the prostate

OBJETIVO: Valorar las variaciones plasmáticas de PSA durante y después de la administración de BCG intravesical y su relación con la RTU previa de próstata. MÉTODOS: Se estudia la variación de las concentraciones de PSA después de cada instilación, al mes y a los tres meses, en 24 pacientes afectos de tumor vesical superficial y/o cis, tratados con instilaciones endovesicales de BCG semanalmente. Tres pacientes habían sido sometidos a resección transuretral de próstata (RTU). RESULTADOS: Se observó una elevación del PSA durante las instilaciones de BCG en el 87,5 per cent, aunque el aumento sólo fue significativo en los pacientes sometidos a RTU de próstata. Presentaron una disminución de los valores al mes y a los 3 meses. CONCLUSIONES: La administración de BCG endovesical produce un aumento de los niveles séricos de PSA. Esta variación es mayor en pacientes con antecedentes de RTU de próstata (AU)