Standardizing The Biochemical Tests for Chronic Kidney Disease (CKD): Where Do We Stand? A National Survey of Laboratories Across Pakistan.

Abstract

Introduction: CKD affects 8.6% of the global population, with South Asian countries seeing prevalence rates between 10.6% and 23.3%, including 21.2% in Pakistan. CKD's burden is further exacerbated in South Asia due to rising hypertension and diabetes. Accurate estimation of glomerular filtration rate (GFR) and albuminuria are vital for CKD management. Despite increasing CKD studies, regional testing remains underdeveloped. This survey evaluates CKD testing practices in Pakistan, aiming to propose recommendations for improving uniformity, enhancing surveillance, and advancing CKD care standards.

Methods: A cross-sectional survey was conducted by the Chemical Pathology section at Aga Khan University (AKU) using a validated questionnaire developed by International Federation of Clinical Chemistry (IFCC) which was modified for local context. The survey, distributed via Google Forms to major laboratories across Pakistan, focused on CKD testing methods. Data were analyzed using Excel (Microsoft Corporation, 2018) software.

Results: A total of 13 laboratories participated in the survey. All laboratories measured serum creatinine, while two measured serum cystatin C, eleven measured urinary protein, and ten measured urinary albumin. GFR was estimated using equations in 10 laboratories, with CKD-EPI 2021 (29%), MDRD (22%), and CKD-EPI Pak (14%) being the most commonly used. However, only six laboratories employed pediatric equations for children. Significant variability was observed in the testing methods for serum creatinine, urinary protein, and urinary albumin.

Conclusion: Our findings emphasize the urgent need to standardize CKD testing in Pakistan. Inconsistencies in estimated GFR reporting, serum creatinine measurement and proteinuria testing highlight the need for harmonized protocols to improve diagnosis, management, and public health outcomes.