Time for change in CKD assessment, treatment

Chronic kidney disease is becoming more prevalent, but early diagnosis is tricky.

By Victoria Stagg Elliott, AMNews staff. June 11, 2007.

To improve the detection and management of the growing number of patients with chronic kidney disease, the formula commonly used for diagnosis and staging needs to be refined, according to a session at the American Society of Hypertension scientific meeting in Chicago last month.

"We need to address the issues of estimating glomerular filtration rate and quantifying albuminuria/proteinuria," said Matthew R. Weir, MD, one of the speakers and director of the division of nephrology at the University of Maryland School of Medicine in Baltimore.

Experts complained that the Modification of Diet in Renal Disease -- or MDRD -- formula used to estimate the GFR is not as accurate at the earlier stages of chronic kidney disease or for patients who are older. The tool is too reliant on creatinine, which can be affected by a person's size and muscle mass. The laboratory assays for this waste product are not standardized, although the issue is one on which the National Kidney Disease Education Program is working.

"It's very good for GFRs below 60, but there's a lot of imprecision in people with GFRs above 60," said Edgar R. Miller, MD, PhD, who also spoke at the session and is an associate professor of medicine in the division of general internal medicine at Johns Hopkins University in Baltimore.