title: Variability of creatinine measurements in clinical laboratories: results from the CRIC study.
abstract: OBJECTIVE
  Estimating equations using serum creatinine (SCr) are often used to assess glomerular filtration rate (GFR). Such creatinine (Cr)-based formulae may produce biased estimates of GFR when using Cr measurements that have not been calibrated to reference laboratories. In this paper, we sought to examine the degree of this variation in Cr assays in several laboratories associated with academic medical centers affiliated with the Chronic Renal Insufficiency Cohort (CRIC) Study; to consider how best to correct for this variation, and to quantify the impact of such corrections on eligibility for participation in CRIC. Variability of Cr is of particular concern in the conduct of CRIC, a large multicenter study of subjects with chronic renal disease, because eligibility for the study depends on Cr-based assessment of GFR.
  
  
  METHODS
  A library of 5 large volume plasma specimens from apheresis patients was assembled, representing levels of plasma Cr from 0.8 to 2.4 mg/dl. Samples from this library were used for measurement of Cr at each of the 14 CRIC laboratories repetitively over time. We used graphical displays and linear regression methods to examine the variability in Cr, and used linear regression to develop calibration equations. We also examined the impact of the various calibration equations on the proportion of subjects screened as potential participants who were actually eligible for the study.
  
  
  RESULTS
  There was substantial variability in Cr assays across laboratories and over time. We developed calibration equations for each laboratory; these equations varied substantially among laboratories and somewhat over time in some laboratories. The laboratory site contributed the most to variability (51% of the variance unexplained by the specimen) and variation with time accounted for another 15%. In some laboratories, calibration equations resulted in differences in eligibility for CRIC of as much as 20%.
  
  
  CONCLUSIONS
  The substantial variability in SCr assays across laboratories necessitates calibration of SCr measures to a common standard. Failing to do so may substantially affect study eligibility and clinical interpretations when they are determined by Cr-based estimates of GFR.
authors.affiliation: Department of Medicine and Hypertension and Renal Center, Tulane University, New Orleans, LA 70112, USA.
authors.forename: Marshall
authors.initials: M
authors.lastname: Joffe
authors.forename: Chi-yuan
authors.initials: CY
authors.lastname: Hsu
authors.forename: Harold I
authors.initials: HI
authors.lastname: Feldman
authors.forename: Matthew
authors.initials: M
authors.lastname: Weir
authors.forename: J R
authors.initials: JR
authors.lastname: Landis
authors.forename: L Lee
authors.initials: LL
authors.lastname: Hamm
mesh_terms: D000328:Adult; D001781:Blood Component Removal; D002138:Calibration; D002624:Chemistry, Clinical / Q000379:methods*; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007753:Laboratories; D008297:Male; D015233:Models, Statistical; D051436:Renal Insufficiency, Chronic / Q000097:blood*; D015203:Reproducibility of Results; D013997:Time Factors
chemical_list: D003404:Creatinine
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