By Vrajesh Pandya, PhD, DABCC, FADLM
A critical scientific session on Monday afternoon, titled, “What the lab reports matters: Impact of eGFR reporting on drug decisions in clinical practice,” will spotlight the imminent need for standardization in kidney function assessment. The session will feature a panel of multidisciplinary experts who have played long-standing roles in shaping U.S. kidney care policy through the National Kidney Foundation (NKF) and the American Society of Nephrology (ASN).
At the heart of the discussion is the estimated glomerular filtration rate (eGFR), a key metric derived from serum creatinine and/or cystatin C concentrations. Although eGFR is essential for diagnosing and staging chronic kidney disease (CKD), its clinical use remains inconsistent across laboratories, pharmacy teams, and nephrology providers.
“There’s a clear lack of standardization in how kidney function is evaluated,” says Greg Miller, PhD, DABCC, professor of pathology at Virginia Commonwealth University. “We’ve made progress in standardizing creatinine assay calibration, but selectivity issues persist — especially with Jaffe-based methods, which are still used by about 68% of U.S. labs,” he says. “Jaffe methods can overestimate creatinine in patients with high glucose or ketone levels, such as those with diabetes.”
Miller, who will moderate the session, emphasizes the importance of transitioning to race-neutral eGFR equations. “The continued use of outdated, race-based equations is problematic because it contributes to non-standardized interpretation. Labs should adopt the 2021 CKD-EPI creatinine equation or the 2012 cystatin C equation,” both of which are endorsed by NKF-ASN task forces.
Representing the pharmacy perspective, Wendy St. Peter, PharmD, FASN FNKF, FACCP, professor of pharmacy at the University of Minnesota, stresses the need for consistency in kidney function reporting. “The Cockcroft-Gault equation is near and dear to pharmacists for drug-dosing decisions, but newer evidence supports the 2021 CKD-EPI equations as more accurate,” she explains. “These equations are based on larger, more diverse cohorts and better reflect true kidney function across our U.S. population.”
St. Peter also advocates for individualized eGFR estimates that account for patient body surface area (BSA). “Assuming a standard BSA of 1.73 m² for all patients is outdated. Our patients vary widely in size, and dosing decisions should reflect that,” she says. She calls for closer collaboration among labs, pharmacists, nephrologists, and IT teams to ensure consistency across healthcare systems. “Labs should clearly indicate which equation they’re using and units (mL/min/1.73m2 or mL/min) on patient reports so clinicians can interpret results appropriately.”
Cynthia Delgado, MD, professor of medicine at the University of California, San Francisco, and a co-chair of the ASN task force on race and kidney diagnostics, underscores the foundational role of laboratory medicine. “Most clinical decisions begin and end with lab results,” she says. “Uniformity in kidney function estimation is essential — not just for diagnosis and treatment, but for preventing confusion as patients move between healthcare systems.”
Delgado warns of the real-world consequences of inconsistency. “Imagine being told you have CKD in one state and not in another, simply because different equations were used,” she says. “This can affect everything from radiologic study approvals to chemotherapy dosing.”
The session will present case-based examples and best practices, drawing on consensus guidance developed by NKF and ASN task forces. With insights from national leaders in laboratory medicine, pharmacy, and nephrology, the session aims to align kidney function reporting with the latest evidence — and ensure safer, more equitable patient care.
