Use of serum creatinine concentration to assess level of kidney function

Chronic kidney disease is a major public health problem in Australia and throughout the world. Based on data from the Ausdiab study,1 it is estimated that over 1.7 million Australian adults have at least a moderately severe reduction in kidney function, defined as an estimated GFR less than 60 mL/min/1.73 m2. This pernicious condition is often not associated with significant symptoms or urinary abnormalities and is unrecognized in 80%−90% of cases.1–3 Chronic kidney disease progresses at a rate that requires approximately 1900 individuals each year in Australia to commence either dialysis or kidney transplantation.4 Furthermore, the presence of CKD is one of the most potent known risk factors for cardiovascular disease, such that individuals with CKD have a 10- to 20-fold greater risk of cardiac death than age- and sex-matched controls without CKD.5,6 Early detection of CKD in the primary care setting is therefore critically important for facilitating the timely institution of therapies proven to slow or prevent kidney failure progression, enhance the appropriate assessment and modification of cardiovascular risk, and inform decisions regarding the prescription of drugs excreted by the kidneys.7,8