title: Routine serum creatinine measurements: how well do we perform?
abstract: BACKGROUND
  The first aim of the study was to investigate the accuracy and intra-laboratory variation of serum creatinine measurements in clinical laboratories in Flanders. The second purpose was to check the effect of this variation in serum creatinine concentration results on the calculated estimated glomerular filtration rate (eGFR) and the impact on classification of patients into a chronic kidney disease (CKD) stage.
  
  
  METHODS
  26 routine instruments were included, representing 13 different types of analyzers from 6 manufacturers and covering all current methodologies (Jaffe, compensated Jaffe, enzymatic liquid and dry chemistry methods). Target values of five serum pools (creatinine concentrations ranging from 35 to 934 μmol/L) were assigned by the gold standard method (ID-GC/MS).
  
  
  RESULTS
  Intra-run CV (%) (n = 5) and bias (%) from the target values were higher for low creatinine concentrations. Especially Jaffe and enzymatic dry chemistry methods showed a higher error. The calculated eGFR values corresponding with the reported creatinine concentration ranges resulted in a different CKD classification in 47% of cases.
  
  
  CONCLUSIONS
  Although most creatinine assays claim to be traceable to the gold standard (ID-GC/MS), large inter-assay differences still exist. The inaccuracy in the lower concentration range is of particular concern and may lead to clinical misinterpretation when the creatinine-based eGFR of the patient is used for CKD staging. Further research to improve harmonization between methods is required.
authors: Interdisciplinary Research Facility Life Sciences, Katholieke Universiteit Leuven Campus Kortrijk, Kortrijk, Belgium. liesbeth.hoste@kuleuven-kulak.be.
authors: Liesbeth
authors: L
authors: Hoste
authors: Department of Clinical Chemistry and Toxicology, AZ Groeninge Hospital, Reepkaai 4, B8500, Kortrijk, Belgium. kathleen.deiteren@telenet.be.
authors: Kathleen
authors: K
authors: Deiteren
authors: Interdisciplinary Research Facility Life Sciences, Katholieke Universiteit Leuven Campus Kortrijk, Kortrijk, Belgium. hans.pottel@kuleuven-kulak.be.
authors: Hans
authors: H
authors: Pottel
authors: Department of Clinical Chemistry and Toxicology, AZ Groeninge Hospital, Reepkaai 4, B8500, Kortrijk, Belgium. nico.callewaert@azgroeninge.be.
authors: Nico
authors: N
authors: Callewaert
authors: Department of Clinical Chemistry and Toxicology, AZ Groeninge Hospital, Reepkaai 4, B8500, Kortrijk, Belgium. f.martens@skynet.be.
authors: Frank
authors: F
authors: Martens
mesh_terms: D000328:Adult; D000368:Aged; D002648:Child; D003404:Creatinine / Q000097:blood*; D003955:Diagnostic Tests, Routine; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D007753:Laboratories; D008297:Male; D013058:Mass Spectrometry / Q000379:methods*; D011786:Quality Control; D012015:Reference Standards; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000175:diagnosis; D012494:Sampling Studies
chemical_list: D003404:Creatinine