Speaking of unintended consequences, a new study questions the cost-effectiveness of using a widely used formula to estimate patientsí glomerular filtration rate (eGFR). Use of the eGFR can identify patients with chronic kidney disease (CKD) who would not have been identified by simply looking at creatinine levels. Here in Western New York, we actually pioneered community-wide use of the eGFR to promote earlier identification of CKD (see Boissonault 2003). The new study (Sydney et al 2009) appears in the Clinical Journal of the American Society of Nephrology. It confirms the positive outcomes of using eGFR (identifying CKD earlier, preventing some deaths and progression to ESRD). However, it also notes the potential impact of false negative test results (identifying some incorrectly as having CKD). Those patients often undergo further testing that may not have been necessary. The final answer on the widespread use of estimated GFRís will await further population-based studies. But this, again, is a great example of how you must always be vigilant for unintended consequences any time you introduce an intervention you expect to have positive outcomes.
Boissonnault, BA. Chronic kidney disease project in Buffalo N.Y.: A community-wide approach identifying, education and treating CKD patients. Dialysis Times, 9:5:2Ė3, 7, 2003
Sydney C.W. Tang, Bing L, Andrew S.H. Lai, Clara B.Y. Pang, Wai Kuen Tso, Pek Lan Khong, Mary Ip, Kar Neng Lai. The costs and benefits of automatic estimated glomerular filtration rate reporting. Clinical Journal of the American Society of Nephrology (CJASN) 2009 4(2): February 1, 2009