Recommendations for Improving Serum Creatinine Measurement: A Report From the Laboratory Working Group of the National Kidney Disease Education Program

Published

October 12, 2021

Author(s)

Gary L. Myers, W. G. Miller, J Coresh, J Fleming, Neil Greenberg, T Greene, T Hostetter, A S. Levey, Mauro Panteghini, Michael J. Welch, John H. Eckfeldt

Abstract

Background:The National Kidney Disease Education Program (NKDEP) has promulgated suggestions for diagnosing and treating chronic kidney disease (CKD). The National Kidney Foundation s Kidney Disease Outcomes Quality Initiative (K/DOQI) has issued clinical guidelines to define and classify stages of severity of CKD using estimating equations for glomerular filtration rate (GFR) based on serum creatinine concentration. Both organizations recommend using the estimating equation that was developed from the Modification of Diet in Renal Disease (MDRD) Study. Unfortunately, the current variability in calibration of serum creatinine methods renders all estimating equations less accurate in the reference (normal) interval of serum creatinine concentration, which is the relevant range for detecting early stages of CKD (GFR <60 mL/min/1.73 m2).Approach:The National Kidney Disease Education Program formed a Laboratory Working Group to review critically and address the problems and issues related to serum creatinine measurement for estimating GFR and to prepare recommendations to standardize and improve creatinine measurement.Content:We present an overview of the commonly used methods for the determination of serum creatinine, limitations of these methods, and method performance as evaluated in proficiency testing programs. Biological variations in GFR and serum creatinine are discussed in conjunction with the development of analytical performance criteria for serum creatinine measurement. Available resources for standardization of serum creatinine measurement are discussed and recommendations for measurement improvement are given.

Citation

Clinical Chemistry

Pub Type

Journals

Keywords

biological variation, chronic kidney disease, glomerular filtration rate, MDRD equation, serum creatinine, standardization

Citation

Myers, G. , Miller, W. , Coresh, J. , Fleming, J. , Greenberg, N. , Greene, T. , Hostetter, T. , Levey, A. , Panteghini, M. , Welch, M. and Eckfeldt, J. (2021), Recommendations for Improving Serum Creatinine Measurement: A Report From the Laboratory Working Group of the National Kidney Disease Education Program, Clinical Chemistry (Accessed November 5, 2025)