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eGFR debate reignites

Experts claim eGFR is effectively a screening tool without meeting national criteria

Heated debate over the use of eGFR to identify patients with chronic kidney disease has reignited, after experts warned the controversial formula may do more harm than good.

Management of CKD has been mired in controversy since its inclusion in the quality and outcomes framework, with GPs claiming it is a huge amount of extra work that brings little benefit to patients. Hospital specialists have also been concerned the move will swamp them with referrals.

Now experts have claimed in a BMJ analysis that the introduction of eGFR is putting pressure on specialist services and is making patients anxious without clear proof of benefit. Professor David Fitzmaurice, professor of primary care at the University of Birmingham, claimed that 'uncritical introduction' of eGFR in adults with normal serum creatinine and no other indication of renal disease lacks 'good scientific basis'.

He said: 'Because serum creatinine is so insensitive for detecting early loss of renal function it is tempting to suppose eGFR is a better measurement. But this is not true.'

He warned eGFR was effectively a screening test without meeting national screening programme criteria.

Dr Jo Richardson, a GP in Isle of Dogs, east London, agreed: 'The ethics of the situation demand that we halt the unnecessary anxiety currently caused to large numbers of patients who receive false positive results.'

But Professor Mike Kirby, director of the Hertfordshire Primary Care Research Network and a GP in Letchworth, Hertfordshire, disagreed and said eGFR was a better test than serum creatinine.

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