La diagnostica di laboratorio della malattia renale cronica in Italia : armonizzare è d’obbligo = The laboratory role in chronic kidney disease (CKD) in Italy : need of harmonization

The laboratory role in chronic kidney disease (CKD) in Italy: need of harmonization. The diagnosis and classification of CKD are based on laboratory tests. Aim of this paper is to examine different aspects of the laboratory contribution to verify their harmonization at national level. We review relationships between laboratory and clinical organizations, the role of 2012 Kidney Disease Improving Global Outcomes (KDIGO) guidelines, the quality of creatinine and urine albumin measurements, the status of estimated glomerular filtration rate (eGFR) reporting, the use of cystatin C and testing plans. Questionnaires examining different aspects of the CKD diagnostics were sent out and EQAS for creatinine and urine albumin measurements were carried out. For creatinine measurement, enzymatic assays show the best performance, while for urine albumin a bias still exists between different methods. The eGFR is routinely reported by 75% of surveyed laboratories, but only 15% of them use the equation derived by the CKD-Epidemiology Collaboration (CKD-EPI) study. For urine albumin, the recommended first morning void sample is used by ~60% of laboratories, but the wrong terminology of “microalbuminuria” is still used by >40% of them. Cystatin C is offered by a minority of laboratories. In conclusion, even if an improvement can be observed during the recent years, efforts for a better alignment to international recommendations are needed. Often they just require cultural and organizational changes, without the availability of additional economic resources.