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10.11.2021 | Brief Report

Large inter-assay difference of serum creatinine in pediatric population: a threat to accurate staging of chronic kidney disease

verfasst von: Kriselle Lao, Elizabeth Sykes, Xander M. R. van Wijk, Jieli Li, JoAnna Williams, Carmen Gherasim, Qian Sun

Erschienen in: Pediatric Nephrology | Ausgabe 3/2022

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Abstract

Background

Serum creatinine concentration is a primary component of Bedside Schwartz equation for estimated glomerular filtration rate (eGFR) in children. To standardize creatinine measurement, most manufacturers have adopted calibration procedures traceable to isotope dilution mass spectrometry (IDMS) using National Institute of Standards and Technology reference material. However, reference material representing much lower creatinine concentrations seen in children is not available and it is unclear how well commercial assays perform at pediatric levels.

Methods

One thousand nine hundred seventy-one specimens from consecutive children <19 years, with creatinine ≤0.8 mg/dL by Abbott Jaffe method were included. Creatinine measurements were compared between Abbott-Jaffe and Abbott-enzymatic methods. Furthermore, we evaluated performance of six commercial creatinine assays at concentrations seen in pediatric patients utilizing IDMS traceable serum samples.

Results

Median difference (enzymatic-Jaffe) for prepubertal females was –0.18 mg/dL (2.5%tile, 97.5%tile: –0.30, –0.06), –0.12 mg/dL (–0.25, –0.00) for pubertal females, –0.17  mg/dL (–0.30, –0.04) for prepubertal males, –0.11 mg/dL (–0.24, 0.01) for pubertal males. Bias appeared proportional for each subgroup and decreased as creatinine concentrations increased. Using IDMS traceable samples, the greatest inter-assay variability was seen with the lowest creatinine levels (target 0.273 mg/dL), where 67% (4/6) of methods failed to reach minimal bias specification of 8% (range –7.5 to 86%). For samples with higher creatinine targets (0.440–0.634 mg/dL), two methods failed to meet minimal bias specification, whereas four showed bias <8%.

Conclusion

Many commonly used creatinine assays remain inaccurate for pediatric populations after over a decade of nationwide efforts to standardize measurements. When creatinine-based eGFR is used for chronic kidney disease (CKD) staging in children, large inter-assay variability can lead to disease misclassification, inappropriate diagnostic and therapeutic interventions.

Graphical abstract

A higher resolution version of the Graphical abstract is available as Supplementary information
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Literatur
1.
Zurück zum Zitat Myers GL, Miller GW, Coresh J, Fleming J, Greenberg N, Greene T, Hostetter T, Levey AS, Panteghini M, Welch M, Eckfeldt JH (2006) Recommendations for improving serum creatinine measurement: a report from the Laboratory Working Group of the National Kidney Disease Education Program. Clin Chem 52:5–18CrossRef Myers GL, Miller GW, Coresh J, Fleming J, Greenberg N, Greene T, Hostetter T, Levey AS, Panteghini M, Welch M, Eckfeldt JH (2006) Recommendations for improving serum creatinine measurement: a report from the Laboratory Working Group of the National Kidney Disease Education Program. Clin Chem 52:5–18CrossRef
2.
Zurück zum Zitat Mian AN, Schwartz GJ (2017) Measurement and estimation of glomerular filtration rate in children. Adv Chronic Kidney Dis 24:348–356CrossRef Mian AN, Schwartz GJ (2017) Measurement and estimation of glomerular filtration rate in children. Adv Chronic Kidney Dis 24:348–356CrossRef
3.
Zurück zum Zitat Hoste L, Deiteren K, Pottel H, Callewaert N, Martens F (2015) Routine serum creatinine measurements: how well do we perform? BMC Nephrol 16:21CrossRef Hoste L, Deiteren K, Pottel H, Callewaert N, Martens F (2015) Routine serum creatinine measurements: how well do we perform? BMC Nephrol 16:21CrossRef
4.
Zurück zum Zitat Killeen AA, Ashwood ER, Ventura CB, Styer P (2013) Recent trends in performance and current state of creatinine assays. Arch Pathol Lab Med 137:496–502CrossRef Killeen AA, Ashwood ER, Ventura CB, Styer P (2013) Recent trends in performance and current state of creatinine assays. Arch Pathol Lab Med 137:496–502CrossRef
5.
Zurück zum Zitat Schwartz GJ, Kwong T, Erway B, Warady B, Sokoll L, Hellerstein S, Dharnidharka V, Furth S, Muñoz A (2009) Validation of creatinine assays utilizing HPLC and IDMS traceable standards in sera of children. Pediatr Nephrol 24:113–119CrossRef Schwartz GJ, Kwong T, Erway B, Warady B, Sokoll L, Hellerstein S, Dharnidharka V, Furth S, Muñoz A (2009) Validation of creatinine assays utilizing HPLC and IDMS traceable standards in sera of children. Pediatr Nephrol 24:113–119CrossRef
7.
Zurück zum Zitat Jassam N, Weykamp C, Thomas A, Secchiero S, Sciacovelli L, Plebani M, Thelen M, Cobbaert C, Perich C, Ricós C, Paula FA, Barth JH (2017) Post-standardization of routine creatinine assays: are they suitable for clinical applications. Ann Clin Biochem 54:386–394CrossRef Jassam N, Weykamp C, Thomas A, Secchiero S, Sciacovelli L, Plebani M, Thelen M, Cobbaert C, Perich C, Ricós C, Paula FA, Barth JH (2017) Post-standardization of routine creatinine assays: are they suitable for clinical applications. Ann Clin Biochem 54:386–394CrossRef
8.
Zurück zum Zitat Andersen TB, Erlandsen EJ, Frøkiaer J, Eskild-Jensen A, Brøchner-Mortensen J (2010) Comparison of within- and between-subject variation of serum cystatin C and serum creatinine in children aged 2–13 years. Scand J Clin Lab Invest 70:54–59CrossRef Andersen TB, Erlandsen EJ, Frøkiaer J, Eskild-Jensen A, Brøchner-Mortensen J (2010) Comparison of within- and between-subject variation of serum cystatin C and serum creatinine in children aged 2–13 years. Scand J Clin Lab Invest 70:54–59CrossRef
10.
Zurück zum Zitat Cobbaert CM, Baadenhuijsen H, Weykamp CW (2009) Prime time for enzymatic creatinine methods in pediatrics. Clin Chem 55:549–558CrossRef Cobbaert CM, Baadenhuijsen H, Weykamp CW (2009) Prime time for enzymatic creatinine methods in pediatrics. Clin Chem 55:549–558CrossRef
11.
Zurück zum Zitat Greenberg N, Roberts WL, Bachmann LM, Wright EC, Dalton RN, Zakowski JJ, Miller WG (2012) Specificity characteristics of 7 commercial creatinine measurement procedures by enzymatic and Jaffe method principles. Clin Chem 58:391–401CrossRef Greenberg N, Roberts WL, Bachmann LM, Wright EC, Dalton RN, Zakowski JJ, Miller WG (2012) Specificity characteristics of 7 commercial creatinine measurement procedures by enzymatic and Jaffe method principles. Clin Chem 58:391–401CrossRef
12.
Zurück zum Zitat Owen LJ, Keevil BG (2007) Does bilirubin cause interference in Roche creatinine methods? Clin Chem 53:370–371CrossRef Owen LJ, Keevil BG (2007) Does bilirubin cause interference in Roche creatinine methods? Clin Chem 53:370–371CrossRef
13.
Zurück zum Zitat Delanaye P, Cavalier E, Pottel H (2017) Serum Creatinine: Not So Simple! Nephron 136:302–308CrossRef Delanaye P, Cavalier E, Pottel H (2017) Serum Creatinine: Not So Simple! Nephron 136:302–308CrossRef
Metadaten
Titel
Large inter-assay difference of serum creatinine in pediatric population: a threat to accurate staging of chronic kidney disease
verfasst von
Kriselle Lao
Elizabeth Sykes
Xander M. R. van Wijk
Jieli Li
JoAnna Williams
Carmen Gherasim
Qian Sun
Publikationsdatum
10.11.2021
Verlag
Springer Berlin Heidelberg
Erschienen in
Pediatric Nephrology / Ausgabe 3/2022
Print ISSN: 0931-041X
Elektronische ISSN: 1432-198X
DOI
https://doi.org/10.1007/s00467-021-05335-x

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