PhD ceremony Ms. I. Drion: Renal function estimation. The implications for clinical practice

PhD ceremony: Ms. I. Drion

Dissertation: Renal function estimation. The implications for clinical practice

Promotor(s): prof. H.J.G. Bilo, prof. J.F.M. Wetzels

Faculty: Medical Sciences

General practitioners have an important task in the detection of Chronic Kidney Disease (CKD). To be able to recognize CKD adequately a clear definition and classification system was needed. Equations to estimate renal function became an important component of this classifications system. Although, decisions in clinical practice are frequently taken based on the outcomes of these equations, the use of these equations has many drawbacks as sketched in this thesis. We have come to the conclusion that the accuracy of the estimated glomerular filtration rate (eGFR) equations for the individual remains doubtful, and outcomes of these equations should be used as an indicator, not as a true value. Moreover, for most elderly people with moderate renal function without signs of renal damage, moderate reductions of eGFR should be seen as part and parcel of their life, instead of extensive follow-up, additional diagnostics and treatment as is recommended in many CKD guidelines. Also, attention should be paid to the method of creatinine measurement that is used, since the accuracy of creatinine measurements will have impact on the accuracy of renal function estimating equations. Based on the results of this thesis the Jaffe method should be abandoned. Finally, subjects with renal failure are vulnerable to adverse drug events. In this group there is an ongoing need to improve medication safety and prevention of adverse drug events. As is shown in this thesis extending the availability of renal function data towards community pharmacists is one of the effective means to achieve this.