Postanalytical External Quality Assessment of Urine Albumin in Primary Health Care: An International Survey

Aakre, Kristin Moberg; Thue, Geir; Subramaniam-Haavik, Sumathi; Bukve, Tone; Morris, Howard A.; Müller, Mathias M.; Lovrenčić, Marijana Vučić; Plum, Inger; Kallion, Kaja; Aab, Alar; Kutt, Marge; Gillery, Philippe; Schneider, Nathalie; Horvath, Andrea R.; Ónody, Rita; Oosterhuis, Wytze P.; Ricós, Carmen; Perich, Carmen; Nordin, Gunnar; Sandberg, Sverre

doi:10.1373/clinchem.2007.100917

Cited by 25 publications

(18 citation statements)

References 14 publications

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“…This activity should be extended and be an integrated part of all EQAS activity (7). Post-analytical schemes have been conducted on a project basis across European countries for different POCT analysis (33)(34)(35). For anticoagulation treatment a post-analytical scheme is established in the Czech Republic (15), and recently a post-analytical survey for INR has been carried out in fourteen European countries (personal communication).…”

Section: Discussionmentioning

confidence: 99%

External quality assessment of point-of-care International Normalized Ratio (INR) testing in Europe

Stavelin

Meijer²,

Kitchen³

et al. 2012

Clinical Chemistry and Laboratory Medicine

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Background: Point-of-care testing (POCT) of prothrombin time, expressed as International Normalized Ratio (INR), is widely used to monitor patients in oral anticoagulation treatment. Guidelines recommend that POCT users should participate in an external quality assessment (EQA) scheme whenever available. The aim of this study was to investigate which European countries provide EQA for POCT INR and to compare how these schemes are organized. Methods: Thirty European countries were invited to participate in this study. Those who reported that they provide EQA for POCT INR filled in a questionnaire dealing with different aspects of their schemes. Results: Nineteen countries reported that they do not provide EQA for POCT INR, while 12 organizations from nine countries reported that they provide this service. Most of these countries circulate lyophilized samples with for the participants unknown target values. Samples with certified INR values and procedures using split samples with fresh patient samples are also used. The acceptability limits vary from 15% to 30%, and the total number of samples circulated per year varies from 1 to 12. Most of the countries organize educational activities together with their schemes. Conclusions: This study demonstrates that there is a wide variation in the way EQA for POCT INR is performed in Europe and that there are many European countries that do not provide this service. Even though our findings indicate that EQA for POCT INR draws some challenges, especially in providing suitable control materials, participation in such schemes is considered useful.

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Section: Discussionmentioning

confidence: 99%

External quality assessment of point-of-care International Normalized Ratio (INR) testing in Europe

Stavelin

Meijer²,

Kitchen³

et al. 2012

Clinical Chemistry and Laboratory Medicine

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“…During 2006, a questionnaire-based evaluation of urine albumin assessment in primary healthcare was conducted in 9 European countries, with replies received from 2078 general practitioners (55 ). Spot urine samples prevailed for first-time examination of urine albumin, whereas timed collections were used to a larger extent for a repeat test, especially when carried out in a hospital laboratory.…”

Section: Urine Sample Collection and Testing Practicesmentioning

confidence: 99%

Current Issues in Measurement and Reporting of Urinary Albumin Excretion

et al. 2009

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BACKGROUND: Urinary excretion of albumin indicates kidney damage and is recognized as a risk factor for progression of kidney disease and cardiovascular disease. The role of urinary albumin measurements has focused attention on the clinical need for accurate and clearly reported results. The National Kidney Disease Education Program and the IFCC convened a conference to assess the current state of preanalytical, analytical, and postanalytical issues affecting urine albumin measurements and to identify areas needing improvement. CONTENT:The chemistry of albumin in urine is incompletely understood. Current guidelines recommend the use of the albumin/creatinine ratio (ACR) as a surrogate for the error-prone collection of timed urine samples. Although ACR results are affected by patient preparation and time of day of sample collection, neither is standardized. Considerable intermethod differences have been reported for both albumin and creatinine measurement, but trueness is unknown because there are no reference measurement procedures for albumin and no reference materials for either analyte in urine. The recommended reference intervals for the ACR do not take into account the large intergroup differences in creatinine excretion (e.g., related to differences in age, sex, and ethnicity) nor the continuous increase in risk related to albumin excretion. DISCUSSION:Clinical needs have been identified for standardization of (a) urine collection methods, (b) urine albumin and creatinine measurements based on a complete reference system, (c) reporting of test results, and (d) reference intervals for the ACR.

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“…The goal of such involvement must be to make them more consistent and more easily understood. The potential for laboratory involvement in the postanalytical application of laboratory tests has been demonstrated in a number of studies, including this report from primary care (11 ).…”

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confidence: 90%

“…The authors of this study (11 ) concluded that guideline recommendations were not being followed and that there was marked variation in whether to use random or spot, early or first-morning urine samples. Timed samples were used extensively in some countries but not in others, and many physicians did not follow up on a positive test result with a repeat test for confirmation.…”

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confidence: 98%

“…Clinical laboratories place less emphasis on the control of preanalytical factors and almost none relating to how laboratory test results are requested, interpreted, and then applied in clinical practice. An innovative study in this issue of Clinical Chemistry (11 ) addresses the challenge in the postanalytical phase. The authors mailed a case history-based questionnaire to primary care physicians in 10 European countries and Australia and received 2298 responses.…”

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Requesting and Interpreting Urine Albumin Measurements in the Primary Health Care Setting

McQueen¹,

Don-Wauchope

2008

Clinical Chemistry

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Postanalytical External Quality Assessment of Urine Albumin in Primary Health Care: An International Survey

Abstract: BACKGROUND: Microalbuminuria (MA) is recognized as an important risk factor for cardiovascular and renal complications in diabetes. We sought to evaluate how screening for MA is conducted and how urine albumin (UA) results are interpreted in primary care internationally.

Cited by 25 publications

References 14 publications

External quality assessment of point-of-care International Normalized Ratio (INR) testing in Europe

External quality assessment of point-of-care International Normalized Ratio (INR) testing in Europe

Current Issues in Measurement and Reporting of Urinary Albumin Excretion

Requesting and Interpreting Urine Albumin Measurements in the Primary Health Care Setting

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