SEQC Spanish Society of Laboratory Medicine

From November 7 to 13, the XV edition of the National Clinical Laboratory Congress (LabClin 2021) was held virtually, organized by the three national clinical laboratory societies, the Spanish Society of Laboratory Medicine (SEQC^ML), the Spanish Association of Medical Biopathology-Laboratory Medicine (AEBM-ML), and the Spanish Clinical Laboratory Association (AEFA).

One of the topics discussed at this congress was the approach to chronic kidney disease (CKD), in which clinical laboratory professionals play an essential role, in the opinion of Dr Sílvia Gràcia, specialist in Clinical Biochemistry, member of the SEQC^ML and associate of the Laboratory Service of the Puigvert Foundation (Barcelona). She considers CKD to be a silent disease with very few symptoms and for which the result of laboratory tests is crucial for the detection, prognosis, and follow-up of patients.

Dr Pastora Rodríguez, president of the organizing committee of LabClin 2021, highlights the broad representation in the Congress of speakers from all specialties of Laboratory Medicine, but also from many other clinical specialties such as Nephrology, Gynaecology, Endocrinology, Intensive Medicine, Oncology, Paediatrics, and Allergology. Clinical laboratories are in constant contact with other services for innovation, participation in clinical care, and clinical decisions.

CKD is the progressive and irreversible deterioration of kidney function and is defined by the presence, over a period of more than three months, of alterations in kidney structure or function with health consequences, regardless of the original cause. This disease affects 1 in 7 adults in Spain (15.1% of the population), a higher prevalence than that estimated in previous studies in our country and similar to that observed in other countries such as Great Britain or the United States. These results support the importance of the health problem posed by CKD, according to Dr Gràcia.

The specialist in Clinical Biochemistry warns us that if it is not diagnosed and treated in time, the most important consequence of CKD is the increase, both very significant and from the initial stages, in morbidity and mortality, mainly of cardiovascular cause, both in at-risk populations and in the general population. On the other hand, replacement treatment (dialysis or kidney transplantation), although affecting only 1% of patients, entails a marked reduction in life expectancy and constitutes one of the most expensive treatments for chronic diseases.

Regarding the population most at risk of developing CKD, Dr Gràcia specifies that they are patients with diabetes or high blood pressure. Other susceptible populations are individuals with a family history, glomerulonephritis, pyelonephritis, lithiasis, and autoimmune diseases, but the range is very wide.

Laboratory tests for chronic kidney disease

Dr Gràcia notes that the laboratory tests performed to detect CKD are fundamentally two: the serum creatinine measurement accompanied by an equation for estimating glomerular filtration (currently the CKD-EPI-2009 equation), and the albumin / creatinine ratio in the first morning urine. These tests make it possible to classify patients into prognostic categories, and determine guidelines for action and criteria for referral to Nephrology.

The specialist from the Puigvert Foundation delves into this, explaining that laboratories are a fundamental pillar in the diagnosis of CKD by incorporating glomerular filtration estimated by means of an equation into laboratory reports. However, the analytical quality of the creatinine measurement methods must be improved, as the results of the SEQC^ML Quality Control Program with switchable material have been reflecting for a long time. This improvement would entail the replacement of Jaffé methods by enzymatic methods, which are the only ones that meet quality specifications based on biological variability criteria.

Regarding the involvement of the SEQC^ML in the study of renal function, Dr Gràcia affirms that the Society has actively participated in the elaboration and updating of consensus documents and recommendations for the evaluation of renal function with other scientific societies, such as the Spanish Society of Nephrology (SEN), the Spanish Association of Paediatric Nephrology (AENP), and the AIDS Study Group (GeSIDA). Recently, it has also participated in updating the SEN Consensus Document on CKD together with eight other scientific societies.