Chronic kidney disease and automatic reporting of estimated glomerular filtration rate: a position statement

Timothy H Mathew, The Australasian Creatinine Consensus Working Group
Med J Aust 2005; 183 (3): 138-141.


  • The systematic staging of chronic kidney disease (CKD) by glomerular filtration measurement and proteinuria has allowed the development of rational and appropriate management plans.

  • One of the barriers to early detection of CKD is the lack of a precise, reliable and consistent measure of kidney function.

  • The most common measure of kidney function is currently serum creatinine concentration. It varies with age, sex, muscle mass and diet, and interlaboratory variation between measurements is as high as 20%.

  • The reference interval for serum creatinine concentration includes up to 25% of people (particularly thin, elderly women) who have an estimated glomerular filtration rate (eGFR) that is significantly reduced (< 60 mL/min/1.73m2).

  • The recent publication of a validated formula (MDRD) to estimate GFR from age, sex, race and serum creatinine concentration, without any requirement for measures of body mass, allows pathology laboratories to “automatically” generate eGFR from data already acquired.

  • Automatic laboratory reporting of eGFR calculated from serum creatinine measurements would help to identify asymptomatic kidney dysfunction at an earlier stage.

  • eGFR correlates well with complications of CKD and an increased risk of adverse outcomes such as cardiovascular morbidity and mortality.

  • We recommend that pathology laboratories automatically report eGFR each time a serum creatinine test is ordered in adults.

  • As the accuracy of eGFR is suboptimal in patients with normal or near-normal renal function, we recommend that calculated eGFRs above 60 mL/min/1.73m2 be reported by laboratories as “> 60 mL/min/1.73m2”, rather than as a precise figure.

Please login with your free MJA account to view this article in full

  • Timothy H Mathew
  • The Australasian Creatinine Consensus Working Group

  • Kidney Health Australia, North Adelaide, SA.


  • 1. Chadban SJ, Briganti EM, Kerr PG, et al. Prevalence of kidney damage in Australian adults: the AusDiab kidney study. J Am Soc Nephrol 2003; 14 (7 Suppl 2): S131-S138.
  • 2. ANZDATA Registry. Twenty-sixth report. Adelaide: Australia and New Zealand Dialysis and Transplant Registry, 2003. Available at: (accessed Jun 2005).
  • 3. Keith DS, Nichols GA, Gullion CM, et al. Longitudinal follow-up and outcomes among a population with chronic kidney disease in a large managed care organization. Arch Intern Med 2004; 164: 659-663.
  • 4. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification and stratification. Am J Kidney Dis 2002; 39 (2 Suppl 1): S1-S266. Available at: (accessed Jun 2005).
  • 5. Levey AS, Bosch JP, Lewis JB, et al. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999; 130: 461-470.
  • 6. Akbari A. Detection of chronic kidney disease with laboratory reporting of estimated glomerular filtration rate and an educational program. Arch Intern Med 2004; 164: 1788-1792.
  • 7. National Kidney Disease Education Program. Information for health professionals. GFR calculator. Available at: (accessed Jun 2005).
  • 8. Joint Specialty Committee on Renal Disease. Chronic kidney disease in adults: UK guidelines for identification, management and referral. June 2005. Available at: (accessed Jun 2005).
  • 9. Chemical Pathology QAP Program. General serum chemistry and therapeutic drugs program. Cycle 66. End-of-cycle report. Sydney: Royal College of Pathologists of Australasia Quality Assurance Programs Pty Ltd, 2004.
  • 10. European Commission Joint Research Centre. The International Measurement Evaluation Programme. Trace and minor constituents in human serum. Geel: Institute for Reference Materials and Measurements, 2003.
  • 11. Tharp R. Renally excreted drug dosing, 2005. Available at: (accessed Jun 2005).
  • 12. Coresh J, Astor BC, Greene T, et al. Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination Survey. Am J Kidney Dis 2003; 41: 1-12.
  • 13. Levey AS, Greene T, Kusek J, et al. Simplified equation to predict glomerular filtration rate from serum creatinine [abstract]. J Am Soc Nephrol 2000; 11: A828.
  • 14. Hallan S, Asberg A, Lindberg M, Johnsen H. Validation of the Modification of Diet in Renal Disease Formula for estimating GFR with special emphasis on calibration of the serum creatinine assay. Am J Kidney Dis 2004; 44: 84-93.
  • 15. Levey AS, Coresh J, Balk E, et al. National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med 2003; 139: 137-147.
  • 16. Rule AD, Larson TS, Bergstralh EJ, et al. Using serum creatinine to estimate glomerular filtration rate: accuracy in good health and in chronic kidney disease. Ann Intern Med 2004; 141: 929-937.
  • 17. Cumming RG, Mitchell P, Craig JC, Knight JF. Renal impairment and anaemia in a population-based study of older people. Intern Med J 2004; 34: 20-23.
  • 18. Go AS, Chertow GM, Fan D, et al. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalisation. N Engl J Med 2004; 351: 1296-1305.
  • 19. Weiner DE, Tighiouart H, Amin M, et al. Chronic kidney disease as a risk factor for cardiovascular disease and all-cause mortality: a pooled analysis of community-based studies. J Am Soc Nephrol 2004; 15: 1307-1315.
  • 20. Anavekar NS, McMurray JJV, Velazquez EJ, et al. Relation between renal dysfunction and cardiovascular outcomes after myocardial infarction. N Engl J Med 2004; 351: 1285-1295.
  • 21. Davies DF, Shock NW. Age changes in glomerular filtration rate, effective renal plasma flow, and tubular excretory capacity in adult males. J Clin Invest 1950; 29: 496-507.
  • 22. National Kidney Disease Education Program. Information for health professionals. Frequently asked questions about estimated GFR values. Available at: (accessed Jun 2005).
  • 23. Zuo L, Ma Y-C, Zhou Y-H, et al. Application of GFR-estimating equations in Chinese patients with chronic kidney disease. Am J Kidney Dis 2005; 45: 463-472.


remove_circle_outline Delete Author
add_circle_outline Add Author

Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Responses are now closed for this article.