LabMed members: access your new renal resources page
You can now find the latest recommendations for acute kidney injury (AKI), chronic kidney disease (CKD) and the kidney failure risk equation (KFRE) in our new ‘renal resources’ section on the LabMed website. You’ll find this by clicking on ‘Our resources’ at the top of the page and ‘Science Knowledge Hub’ in the dropdown menu.
The background
Concerning variation has been found in AKI detection in laboratories across England, including varying creatinine reference ranges and too few LIMS using the AKI algorithm that is required by NHS England.
The UK NEQAS 2022 audit revealed that 31% of respondents were still using the Jaffe creatinine assay, and 47% using inappropriate eGFR equations.
The KFRE is shown to be an accurate predictor of end-stage renal disease and many laboratories are currently setting up a new KFRE service. However, staff are in pressing need of guidance on how to deliver this, as very little has so far been published.
All of this goes on to have a negative effect on standardisation and patient outcomes, making it crucial that it’s addressed.
Why this resource was created
There is a lot of guidance out there, but most is hard to find unless you know where it is. Then there’s the question of whether what you’re looking at is the latest information.
Anna Barton is the Association for Laboratory Medicine’s representative to the UK Kidney Association (UKKA). Through her work bringing the clinical scientist’s view to national renal guidance, she has created an incredibly helpful and comprehensive hub of all the latest information our members need in their work.
“KFRE is a good example. It’s in the NICE CKD guidance but there’s nothing on how to actually implement it” says Anna.
The webpage
Creating this resource as a website allows for more flexibility and constant updating as needed. It’s also easier to access and use on the go.
It covers everything and is very specific for labs. Where guidance doesn’t exist yet (mostly the case for KFRE) Anna has sought out exactly what our members need to know by consulting with Rupert Major, consultant nephrologist and the UK lead for KFRE.
“Where there is no specific guidance, I asked Rupert for his opinion on what the laboratory should do in a certain scenario and other questions that biochemists have asked me.” In this way she acquired information that isn’t available to anyone else, and which is specifically tailored to our members’ needs.
LabMed rep for UKKA
Anna joined the Scientific Affairs and Clinical Practice Committee in 2019, at which time the UKKA requested the input of a biochemist for the work they were doing on AKI. Anna happily agreed due to her strong interest in renal biochemistry.
“It’s always changing and developing. It’s an area in which the lab has a big impact. When we're reporting CKD, AKI, KFRE and it’s important we get it right because obviously it's going to have clinical impact and patient management impact.”
Her involvement snowballed quickly from AKI to CKD and then KFRE.
“It’s strengthening a new link between the biochemists and the nephrologists. We've done a few talks for the UKKA. They're usually quite interested to get the biochemist’s point of view. It’s nice when you're able to input and have an impact on something.”
Policies need more clinical scientist input
A couple of years ago Anna worked on a NICE quality standard guideline after having been recommended by a contact in the UKKA.
“I read the guidance. They had a definition of AKI, but it was the clinical definition, and they were suggesting we (the lab) used that. It simply had not been written by someone with laboratory knowledge, even though it was a section about the laboratory service”. Anna was able to advise on how AKI is detected and reported by laboratories.
“Now that I'm working with the UKKA a lot more guidance has a biochemist’s input, so it makes more sense for us. Before, it didn’t necessarily transfer over to the practical everyday life in a lab.” Anna therefore finds herself inputting a lot on what is actually possible for laboratories, including raising issues such as the variation in age and capabilities of different LIMS.
The future of renal biochemistry
It’s vital that we continue to advocate for our profession’s needs, and an effective way to do this is through collaboration.
“It’s fantastic to now be getting guidance when there has been collaboration and endorsement from different associations. They are more translatable and more practical to the laboratory service and have more oomph.”
Interestingly, Anna has also mentioned something even newer than KFRE looming on the horizon. LabMed is glad to have Anna representing our association and profession in this key area and we’re excited to see what further developments await us.
“It's been a good few years and there’s plenty more to do. It's never stand still.”