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Misinterpretation of Chronic Kidney Disease (CKD) staging in patients with diabetes: creatinine estimation method as a source of error

Authors:

Chathumini Hettiarachchi,

University of Sri Jayewardenepura, LK
About Chathumini
Department of Medical Laboratory Sciences, Faculty of Allied Health Sciences
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Malsha Gunarathna,

University of Sri Jayewardenepura, LK
About Malsha
Department of Medical Laboratory Sciences, Faculty of Allied Health Sciences
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Neranjana Vithanage,

Sri Jayewardenepura General Hospital, LK
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Inoka Uluwaduge ,

University of Sri Jayewardenepura, LK
About Inoka
Department of Basic Sciences, Faculty of Allied Health Sciences
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Samantha Bandara

University of Sri Jayewardenepura, LK
About Samantha
Department of Medical Laboratory Sciences, Faculty of Allied Health Sciences
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Abstract

Background

Serum creatinine is an important laboratory marker of kidney function. It is used in the calculation of eGFR (estimated Glomerular Filtration Rate), which is used in the staging of Chronic Kidney Disease (CKD). In Sri Lanka, kinetic Jaffe and enzymatic methods are used to measure serum creatinine.

 

Objectives

This study investigated the effect of interference by serum glucose on creatinine levels obtained by the kinetic Jaffe reaction compared to enzymatic method and thus their impact on staging of CKD.

 

Methods

A cross-sectional analytical study was conducted in 83 patients with diabetes (serum glucose >180mg/dL). Serum creatinine was measured by kinetic Jaffe and enzymatic methods. Serum glucose values were also recorded in test samples. CKD- Epidemiology Collaboration (CKD-EPI) formula was used to calculate eGFR.

 

Results

The significantly higher creatinine values obtained by the kinetic Jaffe reaction (4.2±3.0mg/dL) in comparison to the enzymatic method (3.4±2.5mg/dL) (p<0.05) led to an underestimation of eGFR values by 27.2% (kinetic Jaffe reaction: 28.9±28.7ml/min/1.73m2, enzymatic method: 38.0±39.1ml/min/1.73m2).

 

Conclusion

Bias in the eGFR values obtained by using serum creatinine from Jaffe reaction led to the misclassification of patients with diabetes into CKD stages. This may have an effect on subsequent monitoring. Therefore, based on clinical findings from the present study, in patients with diabetes and very high glucose levels it is recommended to use the enzymatic method to measure serum creatinine.

How to Cite: Hettiarachchi, C., Gunarathna, M., Vithanage, N., Uluwaduge, I. and Bandara, S., 2022. Misinterpretation of Chronic Kidney Disease (CKD) staging in patients with diabetes: creatinine estimation method as a source of error. Ceylon Journal of Medical Science, 57(2), pp.86–91. DOI: http://doi.org/10.4038/cjms.v57i2.4967
Published on 30 Dec 2022.
Peer Reviewed

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