Evaluation of Kidney Function Testing Practices among Medical Laboratories in Ghana

Evaluation of Kidney Function Testing Practices among Medical Laboratories in Ghana | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Evaluation of Kidney Function Testing Practices among Medical Laboratories in Ghana Prince Adoba, Evans Duah, Emmanuel Toboh, Samuel Amoah, Isaac Acheampong, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7175283/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Kidney function is assessed to detect kidney diseases and help manage individuals with kidney diseases or pathologies that impair the function of the kidneys. Better diagnostic methods that enable early detection of kidney diseases are vital for reversing the disorders in the early stages. This would ultimately prevent progression to advanced stages with significant economic burden and a negative impact on quality of life. This study examined the kidney function testing practices among medical laboratories in Ghana. Methods A structured Google questionnaire form was conveniently used to collect data from 220 medical laboratories across fourteen ( 14 ) regions in Ghana. Results All the teaching hospitals and regional hospitals carry out kidney/renal function tests, with only 79.1% of district hospitals performing such tests. There was no standard nomenclature for such tests. The alkaline picrate (Jaffe’s) method is used by most of the facilities (61.8%) for creatinine estimation, with enzymatic methods used by 58.8%. Most of the facilities did not know whether their creatinine is automatically calibrated to isotope dilution mass spectrometry (IDMS) or not, with 32% reporting their creatinine is calibrated by the manufacturer. Only 9% of facilities correct their creatinine values. For the Glomerular filtration rate (GFR) estimation, 50.6% use the CKD-EPI formula, 15.2% use the Cockcroft-Gault formula, and 14.6% the use MDRD formula in adults. For children, a majority (37.3%) use the CKD-EPI formula, 15.8% use the Cockcroft-Gault formula, 12.7% use the Schwartz formula and 10.8% use the MDRD formula. AKIN, RIFLE, and KDIGO criteria were each used by < 6% of the facilities. Conclusions We recommend that nationwide training, with a well-developed national guideline on kidney function testing, should be organized for scientists on kidney function tests and their limitations. Health sciences/Diseases Health sciences/Health care Health sciences/Medical research Health sciences/Nephrology Kidney function test renal function test kidney disease medical laboratories Introduction Kidney function is assessed to detect kidney diseases and help manage individuals with kidney diseases or pathologies that impair the function of the kidneys. These tests help to identify the presence of renal disease, monitor treatment response, and examine the progression of renal diseases ( 1 ). Kidney diseases encompass a wide range of kidney pathologies that may be acute or chronic. The persistence of impaired kidney function for a duration of > 3 months (> 90 days) delineates chronic kidney disease (CKD) from acute kidney injury (AKI) ( 2 ). AKI is a global problem and a predictor of adverse kidney outcomes. AKI is a significant risk factor for CKD. CKD patients are also likely to develop AKI which can promote the progression of the underlying CKD ( 3 ). The burden of kidney diseases is most critical in developing countries like Ghana where resources and infrastructure for management and renal replacement therapies are limited. In sub-Saharan Africa, the rising incidence of infectious and non-communicable diseases contributes to a potentially high risk for kidney diseases ( 4 – 7 ). Therefore, better diagnostic methods that enable early detection of kidney diseases are key since these conditions can be easily reversed in the early stages ( 8 ). This will ultimately prevent progression to advanced stages with significant economic burden and a negative impact on quality of life ( 9 , 10 ). The inclusion of novel biomarkers of kidney damage to the routine serum creatinine has been proposed for early detection of AKI. Early detection of CKD (stage 1) is reliably detected using albuminuria or proteinuria ( 2 , 3 ) A systematic review observed difficulty in quantifying the true prevalence of CKD in sub-Saharan Africa with unreliable laboratory measurements of kidney function being a major contributing factor ( 11 ). Accurate knowledge by medical laboratory scientists on reliable serum creatinine measurements in GFR estimation and of factors that interferes with creatinine measurement is critical to ongoing global public health efforts to increase kidney disease diagnosis and treatment ( 12 ). Minute variations in creatinine estimation can negatively affect population prevalence estimates ( 13 ). The picric acid (Jaffe) method, though less accurate, is more inexpensive than the enzymatic methods with fewer interferences ( 11 ). Although the enzymatic method is recommended, most laboratories in sub-Saharan African countries including Ghana still use Jaffe’s method. Also, the absence of a standard protocol for kidney function assessment among laboratories in Ghana may result in inconsistent disease burden estimates, with an ultimate effect on the management of affected individuals. This survey sought to examine the knowledge of laboratory professionals and kidney function testing practices among laboratories across Ghana. Materials and Methods Study Design A cross-sectional study was conducted among laboratories in Ghana from May to June 2023. Study Participants A total of 220 medical laboratories across fourteen ( 14 ) regions in Ghana responded to the study. The facilities comprised teaching hospitals, Ghana Health Service (GHS) laboratories, Mission hospitals, Quasi-Government hospitals, and private laboratories. All levels of health facilities with laboratories were included. Ethical Consideration The study was approved by the Research Ethics Committee of the Society of Medical Laboratory Managers Ghana and informed consent sought from study respondents. All protocols were conducted in accordance with the Declaration of Helsinki. Sampling A structured Google questionnaire form was used to collect data using convenience sampling ( https://docs.google.com/forms/d/e/1FAIpQLSf4tlwlj_RLsRxfpyIlaNSixyFcCIiwqRww_hC1aa0xGxRY5Q/viewform?usp=sf_link ). The form was circulated through regional social media platforms of laboratory professionals in Ghana: Society of Medical Laboratory Managers-Ghana (SMLM-G), Ghana Association of Medical Laboratory Scientists (GAMLS), Association of Private Medical Laboratories (APML). One response was taken per laboratory. Data Analysis The data stored in MS Excel was analyzed using IBM Statistical Package for Social Sciences (SPSS) version 26. The region of responding facilities stratified by the performance of kidney/renal function tests was presented using a bar graph. Categorical variables were presented in numbers and percentages. Results General characteristics of respondent facilities are described in Table 1 . A total of 220 facilities responded to the survey, with majority being GHS facilities (52.7%), and at the district hospital level (41.4%). Approximately 72% of the respondents perform kidney/renal function tests. All the teaching hospitals and quasi-government facilities perform kidney/renal function tests, with GHS having the least number of facilities performing kidney/renal function tests. All the respondent regional hospitals and clinics also conduct kidney/renal function tests. Only 13.2% of health centers conduct such tests. In terms of professional cadres, Consultants/PhDs and Specialists/Masters worked in 63.6% and 87.5% of the facilities that perform kidney/renal function tests respectively. Doctor of medical laboratory science and medical laboratory science graduates also worked in 91.7% and 80.2% of facilities that performed such tests respectively. ( Table 1 ) Table 1 General characteristics of respondent facilities. Perform KFT/RFT Variables Total Yes No P-value (N = 220) (N = 158 [71.8%]) (N = 62 [28.2%]) Type of facility < 0.001 Teaching Hospital 10 (4.5) 10 (100.0) 0 (0.0) GHS 116 (52.7) 65 (56.0) 51 (44.0) Mission Hospitals 39 (17.7) 33 (76.7) 10 (23.3) Quasi-Government 12 (5.5) 12 (100.0) 0 (0.0) Private 38 (17.3) 38 (97.4) 1 (2.6) Level of facility < 0.001 Teaching Hospital 10 (4.5) 10 (100.0) 0 (0.0) Regional Hospital 14 (6.4) 14 (100.0) 0 (0.0) District Hospital 91 (41.4) 72 (79.1) 19 (20.9) Polyclinic 27 (12.3) 17 (63.0) 10 (37.0) Clinic 9 (4.1) 9 (100.0) 0 (0.0) Health Center 38 (17.3) 5 (13.2) 33 (86.8) Professional Cadres - Consultant/PhD 22 (10.0) 14 (63.6) 8 (36.4) Specialist/Masters 56 (25.5) 49 (87.5) 7 (12.5) MLSD 60 (27.3) 55 (91.7) 5 (8.3) MLS 172 (78.2) 138 (80.2) 34 (19.8) MLT 150 (68.2) 114 (76.0) 36 (24.0) MLA 107 (48.6) 76 (71.0) 31 (29.0) KFT: Kidney function test; RFT: Renal function test; MLSD: Doctor of Medical Laboratory Sciences; MLS: Medical Laboratory Scientist; MLT: Medical Laboratory Technician; MLA: Medical Laboratory Assistant About 32% of facilities reported using the nomenclature ‘kidney function tests (KFT)’, 27.2% used ‘renal function tests (RFTs)’ and 41.1% used both ‘KFT and RFT’. About 8% of facilities do not report trace levels of urine protein. Alkaline picrate (Jaffe’s) method is used by most of the facilities (61.8%) for creatinine estimation, with enzymatic methods and dry chemistry used by 58.8% and 0.6% respectively. Among those who use the alkaline picrate (Jaffe’s) method, about 72% did not know that the method overestimates creatinine levels and 70% did not know about IDMS calibration. Majority of the GHS (74.3%), Missions (69.2%), Quasi-Government (75%) and private (81.8%) facilities did not know of the overestimation by the alkaline picrate (Jaffe’s) method. About 67% of the teaching hospitals were aware of the overestimation. With respect to IDMS calibration, majority of all types of facilities had no knowledge about it: 66.7% teaching hospitals, 65.7% GHS, 69.2% Missions, 75% Quasi-Government, and 77.3% private. Most of the facilities reported not knowing whether their creatinine is automatically calibrated to IDMS or not, with 32% reporting their creatinine is calibrated by manufacturer. Only 9% of facilities without automatic calibration to IDMS, corrects creatinine to IDMS standards. ( Table 2 ) Table 2 Kidney or Renal function testing methods to type of facility Total TH GHS Missions QG Private Variables (N = 158) (N = 10) (N = 65) (N = 33) (N = 12) (N = 38) Type of Test KFT 50 (31.6) 2 (20.0) 27 (41.5) 6 (18.2) 6 (50.0) 9 (31.6) RFT 43 (27.2) 4 (40.0) 14 (21.5) 12 (36.4) 4 (33.3) 9 (23.7) KFT & RFT 65 (41.1) 4 (40.0) 24 (36.9) 15 (45.5) 2 (16.7) 20 (52.6) Report trace urine protein Yes 145 (91.8) 9 (90.0) 59 (90.8) 33 (100.0) 10 (83.3) 34 (89.5) No 13 (8.2) 1 (10.0) 6 (9.2) 0 (0.0) 2 (16.7) 4 (10.5) Creatinine Estimation Methods Alkaline Picrate (Jaffe) 64 (40.5) 2 (20.0) 27 (41.5) 15 (45.5) 6 (50.0) 14 (36.8) Enzymatic 59 (37.3) 4 (40.0) 30 (46.2) 6 (18.2) 4 (33.3) 15 (39.5) Jaffe & Enzymatic 34 (21.5) 4 (40.0) 8 (12.3) 12 (36.4) 2 (16.7) 8 (21.1) Dry Chemistry 1 (0.6) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (2.6) Overestimation by Jaffe's method Yes 27 (27.8) 4 (66.7) 9 (25.7) 8 (30.8) 2 (25.0) 4 (18.2) No 70 (72.2) 2 (33.3) 26 (74.3) 18 (69.2) 6 (75.0) 18 (81.8) Know IDMS Yes 29 (29.9) 2 (33.3) 12 (34.3) 8 (30.8) 2 (25.0) 5 (22.7) No 68 (70.1) 4 (66.7) 23 (65.7) 18 (69.2) 6 (75.0) 17 (77.3) Creatinine automatically calibrated to IDMS Yes 31 (32.0) 2 (33.3) 9 (25.7) 8 (30.8) 3 (37.5) 9 (40.9) No 9 (9.3) 0 (0.0) 6 (17.1) 2 (7.7) 1 (12.5) 0 (0.0) Do not know 57 (58.8) 4 (66.7) 20 (57.1) 16 (61.5) 4 (50.0) 13 (59.1) Manual correction of creatinine to IDMS Yes 6 (9.1) 1 (25.0) 1 (3.8) 1 (5.6) 1 (20.0) 2 (15.4) No 60 (90.9) 3 (75.0) 25 (96.2) 17 (94.4) 4 (80.0) 11 (84.6) TH: Teaching hospital; GHS: Ghana Health Service; QG: Quasi Government; IDMS: Isotope dilution mass spectrometry For KFT, all the facilities estimate blood urea and blood creatinine tests with 88.7% adding blood electrolytes. Urine dipstick and urine microscopy were examined by 67.8% and 69.6% respectively, and 24-hour urine protein was performed by 12.2%. Urine albumin, albumin-creatinine ratio, and protein-creatinine ratio were analyzed by about 20% of the facilities. Novel markers of blood NGAL, cystatin C, and urine NGAL were estimated by 2.6%, 5.2%, and 1.7% respectively. Approximately 8% perform microalbumin tests. ( Table 3 ) Table 3 Kidney or Renal function tests conducted in laboratories KFT RFT Tests (N = 115) (N = 151) Blood Urea 115 (100.0) 151 (100.0) Blood Creatinine 115 (100.0) 150 (99.3) Blood Electrolytes 102 (88.7) 133 (88.1) Blood NGAL 3 (2.6) 4 (2.6) Blood Cystatin C 6 (5.2) 4 (2.6) Urine Urea 9 (7.8) 19 (12.6) Urine Albumin 23 (20.0) 30 (19.9) Urine NGAL 2 (1.7) 1 (0.7) Albuminuria (Albumin-creatinine ratio) 23 (20.0) 25 (16.6) Proteinuria (Protein-creatinine ratio) 22 (19.1) 21 (13.9) Microalbumin 9 (7.8) 13 (8.6) Urine Dipstick 78 (67.8) 99 (65.6) Urine Microscopy 80 (69.6) 95 (62.9) 24-hour urine Protein 14 (12.2) 12 (7.9) Uric Acid 0 (0.0) 1 (0.7) NGAL: Neutrophil gelatinase-associated lipocalin For RFT, all the facilities estimate blood urea, with 99.3% and 88.15 estimating blood creatinine and blood electrolytes respectively. Urine dipstick and urine microscopy were examined by 65.6% and 62.9% respectively, and 24-hour urine protein was performed by 7.9%. Urine albumin, albumin-creatinine ratio, and protein-creatinine ratio were analyzed by 19.9%, 16.6%, and 13.9% of the facilities respectively. Novel markers of blood NGAL and cystatin C were estimated at 2.6%, and urine NGAL at 0.7%. Approximately 9% perform microalbumin tests as part of RFT. ( Table 3 ) Table 4 presents the GFR estimation methods used by facilities. Most (48.1%) of the facilities manually estimated GFR, 25.9% is automated and 25.9% does not estimated GFR. For adults, 50.6% use the CKD-EPI formula, 15.2% use Cockcroft-Gault formula, 14.6% use MDRD formula, with 1 facility (0.6%) using the Schwartz formula. Majority of all the facility types also used the CKD-EPI formula. For children, 37.3% use the CKD-EPI formula, 15.8% use Cockcroft-Gault formula, 12.7% use the Schwartz formula and 10.8% use the MDRD formula. Table 4 GFR estimation methods among facilities Total TH GHS Missions QG Private Parameters (N = 158) (N = 10) (N = 65) (N = 33) (N = 12) (N = 38) GFR estimation method Manual 76 (48.1) 5 (50.0) 33 (50.8) 14 (42.4) 6 (50.0) 18 (47.4) Automated 41 (25.9) 2 (20.0) 10 (15.4) 9 (27.3) 5 (41.7) 15 (39.5) Do not assess GFR 41 (25.9) 3 (30.0) 22 (33.8) 10 (30.3) 1 (8.3) 5 (13.2) GFR in adults CG 24 (15.2) 1 (10.0) 14 (21.5) 5 (15.2) 0 (0.0) 4 (10.5) MDRD 23 (14.6) 1 (10.0) 9 (13.8) 3 (9.1) 1 (8.3) 9 (23.7) CKD-EPI 80 (50.6) 3 ( 30 ) 35 (53.8) 18 (54.5) 7 (58.3) 17 (44.7) Schwartz 1 (0.6) 0 (0.0) 1 (1.5) 0 (0.0) 0 (0.0) 0 (0.0) GFR in children CG 25 (15.8) 1 (10.0) 13 (20.0) 6 (18.2) 0 (0.0) 5 (13.2) MDRD 17 (10.8) 1 (10.0) 6 (9.2) 3 (9.1) 0 (0.0) 7 (18.4) CKD-EPI 59 (37.3) 2 (20.0) 28 (43.1) 13 (9.1) 3 (25.0) 13 (34.2) Schwartz 20 (12.7) 1 (10.0) 8 (12.3) 4 (12.1) 3 (25.0) 4 (10.5) Not estimated 6 (3.8) 0 (0.0) 2 (3.1) 1 (3.0) 1 (8.3) 2 (5.3) CKD-EPI: Chronic Kidney Disease Epidemiology Collaboration About 80% of the facilities reported using GFR to diagnose and stage CKD. Approximately 33% and 27% used urine dipstick and urine microscopy respectively. Albuminuria was used by 19%, proteinuria by 19.6% and microalbumin by 7.6% of the facilities. Only 0.6% used creatinine alone and it was a GHS facility. For AKI diagnosis and staging, majority (44.9%) of the facilities reported not receiving requests for AKI diagnosis, with 8.9% using no guideline. For those who receive request most of the facility types used BUE/Cr ratio, except quasi-government facilities which majority did not use any guideline. AKIN, RIFLE and KDIGO criteria were used by 1.9%, 4.4% and 5.7% of all the facilities respectively. Creatinine was the commonest test performed for AKI diagnosis (47.5%). GFR was estimated by 44.3% and BUN/Cr by 36.1%. Urine dipstick and urine microscopy were performed by 29.7% and 26.6% respectively. Only 11.4% examined 24-hour urine. NGAL and Cystatin C were the least common tests performed (1.9% and 4.4% respectively). Creatinine was the commonest test by most facility types except Missions and Quasi Governement facilities where majority performed GFR. ( Table 5 ) Table 5 CKD and AKI diagnosis with type of facility Total TH GHS Missions QG Private Parameters (N = 158) (N = 10) (N = 65) (N = 33) (N = 12) (N = 38) CKD Diagnosis and Staging Creatine alone 1 (0.6) 0 (0.0) 1 (1.5) 0 (0.0) 0 (0.0) 0 (0.0) GFR 127 (80.4) 8 (80.0) 48 (73.8) 27 (81.8) 10 (83.3) 34 (89.5) Albuminuria 30 (19.0) 3 (30.0) 8 (12.3) 7 (21.2) 2 (16.7) 10 (26.3) Proteinuria 31 (19.6) 3 (30.0) 12 (18.5) 7 (21.2) 3 (25.0) 6 (15.8) Microalbumin 12 (7.6) 2 (20.0) 3 (4.6) 3 (9.1) 1 (8.3) 3 (7.9) Urine Dipstick 52 (32.9) 4 (40.0) 16 (24.6) 14 (42.4) 6 (50.0) 12 (31.6) Urine Microscopy 42 (26.6) 2 (20.0) 13 (20.0) 12 (36.4) 4 (33.3) 11 (28.9) AKI Diagnosis and Staging AKIN 3 (1.9) 2 (20.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (2.6) RIFLE 7 (4.4) 2 (20.0) 3 (4.6) 2 (6.1) 0 (0.0) 0 (0.0) KDIGO 9 (5.7) 2 (20.0) 2 (3.1) 1 (3.0) 1 (8.3) 3 (7.9) BUN/Cr 57 (36.1) 5 (50.0) 19 (29.2) 13 (39.4) 2 (16.7) 18 (47.4) GFR 1 (0.6) 0 (0.0) 1 (1.5) 0 (0.0) 0 (0.0) 0 (0.0) No guideline 14 (8.9) 0 (0.0) 4 (6.2) 6 (18.2) 3 (25.0) 1 (2.6) No request 71 (44.9) 2 (20.0) 36 (55.4) 11 (33.3) 6 (50.0) 16 (42.1) Tests for AKI Creatinine 75 (47.5) 7 (70.0) 30 (46.2) 12 (36.4) 6 (50.0) 20 (52.6) GFR 70 (44.3) 4 (40.0) 29 (44.6) 15 (45.5) 7 (58.3) 15 (39.5) 24-hour urine 18 (11.4) 1 (10.0) 8 (12.3) 4 (12.1) 2 (16.7) 3 (7.9) BUN/Cr 53 (33.5) 3 (30.0) 28 (43.1) 9 (27.3) 1 (8.3) 12 (31.6) Urine Dipstick 47 (29.7) 3 (30.0) 19 (29.2) 8 (24.2) 4 (33.3) 13 (34.2) Urine Microscopy 42 (26.6) 2 (20.0) 17 (26.2) 7 (21.2) 2 (16.7) 14 (36.8) Cystatin C 7 (4.4) 2 (20.0) 4 (6.2) 0 (0.0) 0 (0.0) 1 (2.6) NGAL 3 (1.9) 1 (10.0) 0 (0.0) 0 (0.0) 1 (8.3) 1 (2.6) Discussion Kidney diseases are a major cause of morbidity and mortality worldwide. The ascendance in the incidence of non-communicable and infectious diseases in developing countries like Ghana is associated with a high risk for kidney diseases ( 4 ). This study examined the knowledge and kidney function testing practices among medical laboratories in Ghana. In resource-limited countries, the true estimates of kidney diseases may be precluded by inadequate health infrastructure and resources for diagnosis. In this study, although all the teaching hospitals and regional hospitals perform kidney/renal function tests, only 79.1% of district hospitals perform such tests. This might affect effective diagnosis as well as management of affected patients since it is more convenient to access district hospitals than regional or teaching hospitals by the majority of the populace due to distance and economic reasons. There lacks a uniform and clear nomenclature for tests assessing kidney function in Ghana with some facilities using either kidney function tests (KFT) or renal function tests (RFTs) or both. Others also use the term blood urea electrolytes and creatinine (BUE & Cr) to refer. This has led to different parameters being examined depending on the nomenclature used. The Kidney Disease Improving Global Outcomes (KDIGO) group recommends that terminologies used in describing kidney function and disease should be uniform and easily understood, irrespective of an individual’s level of health literacy ( 14 ). A coherent, shared nomenclature would ensure effective communication at all levels, efficient comparison and integration of datasets, and enable better recognition of gaps in knowledge for future research. A daily excretion of more than 300 mg of protein is referred to as Proteinuria. Normal daily excretion is 150 mg. A urine dipstick detects minute urine protein levels between 100 to 200 mg per day as “trace” ( 1 ). Hence, reporting trace urine dipstick protein can help identify early leakage of proteins in urine. Although the majority of laboratories in the study report trace urine dipstick protein results, others did not. Laboratories should, therefore, report trace urine dipstick protein results for early identification of kidney abnormalities. Creatinine estimations must have a minimal total error to ensure that bias in estimated GFR remains within clinically acceptable limits ( 12 , 15 ). The methods mostly used to estimate serum creatinine among laboratories in Ghana are alkaline picrate (Jaffe) methods and enzymatic assays, with the Jaffe being the most common. The presence of interfering substances results in the overestimation of serum creatinine by 15–25% when the Jaffe method is used. For instance, glucose and acetoacetate are major causes of falsely elevated creatinine in people living with diabetes mellitus with a high risk of developing CKD ( 4 , 12 ). However, among the respondent facilities that used the alkaline picrate (Jaffe’s) method, a higher proportion (72%) did not know that the method overestimates creatinine levels. To overcome the limitations of creatinine estimation, it is recommended that in vitro diagnostic (IVD) manufacturers calibrate serum creatinine methods to be traceable to isotope dilution mass spectrometry (IDMS), or manually corrected ( 12 ). Most of the facilities in this study did not know about IDMS calibration, with the majority not knowing whether their creatinine is automatically calibrated to IDMS or not. Only a few had their creatinine calibrated by the manufacturer or corrected their creatinine to IDMS standards. There is the need for scientists to ensure creatinine measurements are calibrated to IDMS standards and Jaffe results corrected. Regular refresher training on kidney function tests and their limitations is therefore needed for laboratory professionals. The best marker for examining the function of the glomerulus is the glomerular filtration rate (GFR) ( 1 ). GFR is mostly estimated using serum concentrations of blood creatinine or cystatin C, with different GFR estimating equations proposed ( 16 ). MDRD equation, though more reliable than the Cockcroft-Gault equation, has been reported to be imprecise ( 17 , 18 ). Studies conducted in Ghana found the CKD-EPI equation to perform better than other equations for estimating glomerular function ( 19 – 21 ). For adults, about half of the laboratories used the CKD-EPI formula, with few using the Cockcroft-Gault and MDRD formulas. Only one facility used the Schwartz formula. These equations were developed and validated in an adult population. Also, variations in creatinine calibration and imprecise methods have a significant effect on estimating GFR in children, who usually have lower serum creatinine levels. Hence, the Schwartz and the Counahan–Barratt equations have been recommended in children ( 15 , 16 ). In this study, a majority used the CKD-EPI formula followed by the Cockcroft-Gault formula. Only a few (12.7%) used the Schwartz formula. CKD is diagnosed in the laboratory by decreased GFR or markers of kidney damage such as albuminuria or urine sediment abnormalities ( 2 ). Majority of the facilities use GFR to diagnose and stage CKD. Guidelines such as RIFLE, AKIN, and KDIGO have been developed to aid the diagnosis of AKI. The KDIGO AKI guideline integrates the recommendation by RIFLE and AKIN making it the most widely used currently ( 2 , 3 , 22 – 24 ). For AKI diagnosis and staging, the majority of the facilities do not receive requests for AKI diagnosis. For those who received requests, most of the facility types used the BUE/Cr ratio. AKIN, RIFLE, and KDIGO criteria were each used by very few facilities. The KDIGO AKI guidelines combine GFR or serum creatinine and 24-hour urine output in diagnosing and classifying the disorder ( 3 ). However, less than half of the facilities in this study used creatinine or GFR for AKI diagnosis. The use of both the blood creatinine and the urine output is more accurate than the measurement of creatinine alone due to the delay in the rise of creatinine after injury ( 25 ). Urine dipstick and urine microscopy were performed by less than one-third of facilities, with few examining 24-hour urine. Different urine cells, crystals, and casts have been associated with prerenal azotemia and acute tubular necrosis (ATN). ( 26 , 27 ). Hence, urine microscopy can help distinguish these conditions when combined with clinical history. Also, urine microscopy can help detect rare causes of AKI. The finding of significant hematuria, pyuria without bacteriuria, and cellular casts is observed in glomerulonephritis ( 28 ). Pyuria without bacteriuria and/or white blood cell casts is indicative of acute interstitial nephritis ( 29 ). Creatinine is a less sensitive marker and can take 24 to 40 hours to increase in response to kidney injury ( 30 , 31 ). Hence, there has been a search for an early biomarker. Cystatin C has been proposed as a biomarker for earlier detection of changes in kidney function. However, most forms of AKI primarily involve injury in the kidney tubular epithelium, so a decrease in GFR alone (as measured by cystatin C) is not a sensitive or early indicator ( 31 ). Several new AKI biomarkers have been approved for use in humans in different countries, such as TIMP-2*IGFBP7, NGAL, IL-18, etc ( 30 ). The Acute Dialysis Quality Initiative (ADQI) group recommends a combination of damage (NGAL) and functional biomarkers (cystatin C), along with clinical information to improve the diagnostic accuracy of AKI, to recognize the different pathophysiological processes, to discriminate AKI etiology, and to assess AKI severity. Other studies have also reported the stress biomarker, TIMP-2*IGFBP7, to predict early AKI in at-risk individuals ( 32 , 33 ). However, NGAL and Cystatin C were the least common tests performed by laboratories in this study. The inclusion of traditional markers like fractional excretion of sodium or urea, BUE/Cr ratio, and urinalysis in kidney function testing would aid identification of the cause of AKI. A combination of NGAL, cystatin C, and clinical history can be used to improve the diagnostic accuracy of AKI, identify the etiology, and assess disease severity where applicable. Though this is the study first study to assess kidney function testing practices among laboratories in Ghana to the best of our knowledge, it is limited by the use of only online questionnaires for data collection without site inspection by researchers. Conclusion Kidney function testing was performed by most laboratories, but not all district hospitals conducted the test. Knowledge of the limitations of creatinine measurements and standardization was low. Also, GFR estimation as well as AKI and CKD diagnostic practices was inadequate. We recommend that nationwide training should be organized for scientists on kidney function tests and their limitations. A proficiency testing program needs to be instituted to ensure the accuracy and reliability of results from various laboratories in the country. Furthermore, a national guideline on kidney function testing is needed. Abbreviations IDMS Isotope dilution mass spectrometry CKD-EPI Chronic Kidney Disease Epidemiology Collaboration MDRD Modification of Diet in Renal Disease AKIN Acute Kidney Injury Network RIFLE Risk Injury Failure Loss End-stage KDIGO Kidney Disease:Improving Global Outcomes CKD Chronic Kidney Disease AKI Acute Kidney Injury GHS Ghana Health Service KFT Kidney function test RFT Renal Function test NGAL Neutrophil gelatinase-associated lipocalin GFR Glomerular filtration rate TH Teaching Hospital QG Quasi Government Hospital ATN Acute tubular necrosis TIMP2 Tissue Inhibitor metalloproteinase 2 IGFBP7 Insulin-like growth factor binding protein 7 Declarations Ethics approval and consent to participate Approval was sought from the Research Ethics Committee of the Society of Medical Laboratory Managers-Ghana, and the Ghana Association of Medical Laboratory Scientists (GAMLS) before commencing the study. Consent for publication Consent for publication was sought from participating laboratories Availability of data and materials The datasets used in the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that there are no competing interests Funding The study was self-financed by authors Authors’ Contribution PA: Conception and design of the study, data collection and analysis, drafting of the manuscript; ED: Conception and design of the study, data collection and analysis, drafting of the manuscript; ET: Data collection and analysis, drafting of the manuscript; SA: Data collection and analysis, drafting of the manuscript; IA: Data collection and analysis, drafting of the manuscript; FAA: Data collection and analysis, drafting of the manuscript; WT: Data collection and analysis, drafting of the manuscript; MAB: Data collection and analysis, drafting of the manuscript; DSS: Data collection and analysis, drafting of the manuscript; TA: Data collection and analysis, drafting of the manuscript; RKDE: Conception and design of the study, data collection and analysis, drafting of the manuscript. All authors reviewed and approved the manuscript. Acknowledgments We acknowledge the contributions of the regional and national executives of the Society of Medical Laboratory Managers-Ghana, and the Ghana Association of Medical Laboratory Scientists (GAMLS) during the data collection. References Gounden, V., Bhatt, H. & Jialal, I. Renal function tests. In: StatPearls. Treasure Island (FL): StatPearls Publishing. :1–9. (2023). Jadoul, M. et al. KDIGO 2022 Clinical Practice Guideline for the Prevention, Diagnosis, Evaluation, and Treatment of Hepatitis C in Chronic Kidney Disease. Kidney Int. 102 , S129–205 (2022). Khwaja, A. KDIGO Clinical Practice Guidelines for Acute Kidney Injury. Nephron Clin. Pract. 120 , c179–c184 (2012). Fabian, J. et al. Methods and reporting of kidney function: a systematic review of studies from sub-Saharan Africa. Clin. Kidney J. 12 , 778–787 (2019). Ephraim, R. K. D. et al. Chronic kidney disease is common in sickle cell disease: a cross-sectional study in the Tema Metropolis, Ghana. BMC Nephrol. 16 , 75 (2015). Ephraim, R. K. et al. Prevalence of chronic kidney disease among the high-risk population in South-Western Ghana; a cross-sectional study. Can. J. Kidney Health Dis. 2 , 40 (2015). Ephraim, R. K. D. et al. Chronic kidney disease stages among diabetes patients in the Cape Coast Metropolis. Saudi J. Kidney Dis. Transpl. 27 , 1231–1238 (2016). Vaidya, S. R. & Aeddula, N. R. Chronic Renal Failure. In: StatPearls. Treasure Island (FL): StatPearls Publishing; (2023). Tannor, E. K., Archer, E., Kapembwa, K., van Schalkwyk, S. C. & Davids, M. R. Quality of life in patients on chronic dialysis in South Africa: a comparative mixed methods study. BMC Nephrol. 18 , 1–9 (2017). Tannor, E. K. et al. Quality of life among patients with moderate to advanced chronic kidney disease in Ghana - a single centre study. BMC Nephrol. 20 , 122 (2019). Stanifer, J. W. et al. The epidemiology of chronic kidney disease in sub-Saharan Africa: a systematic review and meta-analysis. Lancet Glob Health . 2 , e174–e181 (2014). Myers, G. L. et al. Recommendations for Improving Serum Creatinine Measurement: A Report from the Laboratory Working Group of the National Kidney Disease Education Program. Clin. Chem. 52 , 5–18 (2006). Coresh, J. et al. Action plan for determining and monitoring the prevalence of chronic kidney disease. Kidney Int. Suppl. 7 , 63–70 (2017). Levey, A. S. et al. Nomenclature for kidney function and disease—executive summary and glossary from a Kidney Disease: Improving Global Outcomes (KDIGO) consensus conference. Eur Heart J. ;41:4592–8. (2020). Srivastava, T., Alon, U. S., Althahabi, R. & Garg, U. Impact of Standardization of Creatinine Methodology on the Assessment of Glomerular Filtration Rate in Children. Pediatr. Res. 65 , 113–116 (2009). Ogedegbe, H. O. Renal Function Tests: A Clinical Laboratory Perspective. Lab. Med. 38 , 295–304 (2007). Delanaye, P., Pottel, H., Botev, R. & Con Should we abandon the use of the MDRD equation in favour of the CKD-EPI equation? Nephrol. Dialysis Transplantation . 28 , 1396–1403 (2013). Shirwan, A., Mirza, M. D. & eGFR MDRD Formula has its limitations. Aug 6 [cited 2023 Aug 8]; (2023). Available from: https://www.bmj.com/rapid-response/2011/11/01/egfr-mdrd-formula-has-its-limitations Boima, V. Creatinine based equations and glomerular filtration rate: interpretation and clinical relevance. Ghana. Med. J. 50 , 119–121 (2016). Eastwood, J. B. et al. Assessment of GFR by four methods in adults in Ashanti, Ghana: the need for an eGFR equation for lean African populations. Nephrol. Dial Transpl. 25 , 2178–2187 (2010). Omuse, G. et al. Comparison of equations for estimating glomerular filtration rate in screening for chronic kidney disease in asymptomatic black Africans: a cross sectional study. BMC Nephrol. 18 , 1–8 (2017). Kellum, J. A. et al. Acute kidney injury. Nat. Rev. Dis. Primers . 7 , 1–17 (2021). Moore, P. K., Hsu, R. K. & Liu, K. D. Management of Acute Kidney Injury: Core Curriculum 2018. Am. J. Kidney Dis. 72 , 136–148 (2018). Palevsky, P. M. et al. KDOQI US Commentary on the 2012 KDIGO Clinical Practice Guideline for Acute Kidney Injury. Am. J. Kidney Dis. 61 , 649–672 (2013). El-Khoury, J. M. et al. AACC Guidance Document on Laboratory Investigation of Acute Kidney Injury. J. Appl. Lab. Med. 6 , 1316–1337 (2021). Perazella, M. A., Coca, S. G., Kanbay, M., Brewster, U. C. & Parikh, C. R. Diagnostic Value of Urine Microscopy for Differential Diagnosis of Acute Kidney Injury in Hospitalized Patients. Clin. J. Am. Soc. Nephrol. 3 , 1615–1619 (2008). Perazella, M. A. & Parikh, C. R. How Can Urine Microscopy Influence the Differential Diagnosis of AKI? Clin. J. Am. Soc. Nephrol. 4 , 691 (2009). Cavanaugh, C. & Perazella, M. A. Urine Sediment Examination in the Diagnosis and Management of Kidney Disease: Core Curriculum 2019. Am. J. Kidney Dis. 73 , 258–272 (2019). Nussbaum, E. Z. & Perazella, M. A. Diagnosing acute interstitial nephritis: considerations for clinicians. Clin. Kidney J. ;sfz080. (2019). Ostermann, M. & Joannidis, M. Acute kidney injury 2016: diagnosis and diagnostic workup. Crit. Care . 20 , 299 (2016). Srisawat, N. & Kellum, J. A. The role of biomarkers in acute kidney injury. Crit. Care Clin. 36 , 125–140 (2020). Ostermann, M. et al. Recommendations on Acute Kidney Injury Biomarkers From the Acute Disease Quality Initiative Consensus Conference: A Consensus Statement. JAMA Netw Open. ;3:e2019209. (2020). Sakyi, S. A. et al. Tissue inhibitor metalloproteinase 2 (TIMP-2) and insulin-like growth factor binding protein 7 (IGFBP7) best predicts the development of acute kidney injury. Heliyon 7 , e07960 (2021). Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7175283","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":506571506,"identity":"63f678bd-5a91-4b67-93dd-e15b962f9072","order_by":0,"name":"Prince Adoba","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4UlEQVRIiWNgGAWjYFCCBDYQyQPEjA9ADD5StDAbgBhsxGoBATYJMElIA3978rEHP3fckzFnP3ys8muOnQwbA/PDRzfwaJE48yzdsPdMMY9lT1rabdltyUCHsRkb5+Cz5kaOmQRvWwKPwQ0es9uS25iBWnjYpPFpkQdqkfwL1sL/rVhyWz1hLQZALdJQW9gYP247TFiLIdAvxrJngFrOpBlLM247zsPGTMAvcseTjz18uyPB3uD44Ycff26rtudnb374GK/3QYCxAUIz84BJQsqRtTD+IEb1KBgFo2AUjDgAAAeHRIqw2RVbAAAAAElFTkSuQmCC","orcid":"","institution":"Kwame Nkrumah University of Science and Technology","correspondingAuthor":true,"prefix":"","firstName":"Prince","middleName":"","lastName":"Adoba","suffix":""},{"id":506571508,"identity":"b98bccb8-5dad-483c-8aa1-1905e2c92810","order_by":1,"name":"Evans Duah","email":"","orcid":"","institution":"Cape Coast Teaching Hospital","correspondingAuthor":false,"prefix":"","firstName":"Evans","middleName":"","lastName":"Duah","suffix":""},{"id":506571509,"identity":"51768c3e-cbf8-4a87-a6f2-80c9d478221d","order_by":2,"name":"Emmanuel Toboh","email":"","orcid":"","institution":"Ghana Health Service, Dansoman Polyclinic","correspondingAuthor":false,"prefix":"","firstName":"Emmanuel","middleName":"","lastName":"Toboh","suffix":""},{"id":506571510,"identity":"a9abe25d-a858-4a52-8102-4026177a35b1","order_by":3,"name":"Samuel Amoah","email":"","orcid":"","institution":"University of Cape Coast Hospital","correspondingAuthor":false,"prefix":"","firstName":"Samuel","middleName":"","lastName":"Amoah","suffix":""},{"id":506571511,"identity":"c9c41560-adea-4104-8194-f3742bb5d9fc","order_by":4,"name":"Isaac Acheampong","email":"","orcid":"","institution":"Kwame Nkrumah University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Isaac","middleName":"","lastName":"Acheampong","suffix":""},{"id":506571512,"identity":"20097e38-3411-4bc2-bacb-fead95d63221","order_by":5,"name":"Francis Agyei Amponsah","email":"","orcid":"","institution":"Kwame Nkrumah University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Francis","middleName":"Agyei","lastName":"Amponsah","suffix":""},{"id":506571513,"identity":"045de8e5-0511-4d69-83a0-0b7bff8b9a0f","order_by":6,"name":"Worlanyo Tashie","email":"","orcid":"","institution":"University of Ghana","correspondingAuthor":false,"prefix":"","firstName":"Worlanyo","middleName":"","lastName":"Tashie","suffix":""},{"id":506571514,"identity":"095ab8e6-fb8b-43ee-b537-a29504eedf48","order_by":7,"name":"Michael Afari Baidoo","email":"","orcid":"","institution":"University of Education Winneba","correspondingAuthor":false,"prefix":"","firstName":"Michael","middleName":"Afari","lastName":"Baidoo","suffix":""},{"id":506571515,"identity":"ab6a799d-dd35-49ed-a3d8-2dca4fff3799","order_by":8,"name":"David Sebbie Sackey","email":"","orcid":"","institution":"Komfo Anokye Teaching Hospital","correspondingAuthor":false,"prefix":"","firstName":"David","middleName":"Sebbie","lastName":"Sackey","suffix":""},{"id":506571516,"identity":"5ad89c27-db62-473a-a632-e27c12ccd541","order_by":9,"name":"Tetteh Attoh","email":"","orcid":"","institution":"University of Cape Coast","correspondingAuthor":false,"prefix":"","firstName":"Tetteh","middleName":"","lastName":"Attoh","suffix":""},{"id":506571517,"identity":"79463043-bd8c-4130-9b31-828648110408","order_by":10,"name":"Richard K.D. Ephraim","email":"","orcid":"","institution":"University of Cape Coast","correspondingAuthor":false,"prefix":"","firstName":"Richard","middleName":"K.D.","lastName":"Ephraim","suffix":""}],"badges":[],"createdAt":"2025-07-21 08:54:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7175283/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7175283/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":94470502,"identity":"c1c00d3b-63bc-468b-b80c-7681435ca6d2","added_by":"auto","created_at":"2025-10-27 15:32:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1384932,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7175283/v1/6b6a0518-7366-48c3-b5ea-b78b4be203f0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Evaluation of Kidney Function Testing Practices among Medical Laboratories in Ghana","fulltext":[{"header":"Introduction","content":"\u003cp\u003eKidney function is assessed to detect kidney diseases and help manage individuals with kidney diseases or pathologies that impair the function of the kidneys. These tests help to identify the presence of renal disease, monitor treatment response, and examine the progression of renal diseases (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Kidney diseases encompass a wide range of kidney pathologies that may be acute or chronic. The persistence of impaired kidney function for a duration of \u0026gt;\u0026thinsp;3 months (\u0026gt;\u0026thinsp;90 days) delineates chronic kidney disease (CKD) from acute kidney injury (AKI) (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). AKI is a global problem and a predictor of adverse kidney outcomes. AKI is a significant risk factor for CKD. CKD patients are also likely to develop AKI which can promote the progression of the underlying CKD (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe burden of kidney diseases is most critical in developing countries like Ghana where resources and infrastructure for management and renal replacement therapies are limited. In sub-Saharan Africa, the rising incidence of infectious and non-communicable diseases contributes to a potentially high risk for kidney diseases (\u003cspan additionalcitationids=\"CR5 CR6\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Therefore, better diagnostic methods that enable early detection of kidney diseases are key since these conditions can be easily reversed in the early stages (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). This will ultimately prevent progression to advanced stages with significant economic burden and a negative impact on quality of life (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). The inclusion of novel biomarkers of kidney damage to the routine serum creatinine has been proposed for early detection of AKI. Early detection of CKD (stage 1) is reliably detected using albuminuria or proteinuria (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eA systematic review observed difficulty in quantifying the true prevalence of CKD in sub-Saharan Africa with unreliable laboratory measurements of kidney function being a major contributing factor (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Accurate knowledge by medical laboratory scientists on reliable serum creatinine measurements in GFR estimation and of factors that interferes with creatinine measurement is critical to ongoing global public health efforts to increase kidney disease diagnosis and treatment (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Minute variations in creatinine estimation can negatively affect population prevalence estimates (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). The picric acid (Jaffe) method, though less accurate, is more inexpensive than the enzymatic methods with fewer interferences (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Although the enzymatic method is recommended, most laboratories in sub-Saharan African countries including Ghana still use Jaffe\u0026rsquo;s method. Also, the absence of a standard protocol for kidney function assessment among laboratories in Ghana may result in inconsistent disease burden estimates, with an ultimate effect on the management of affected individuals. This survey sought to examine the knowledge of laboratory professionals and kidney function testing practices among laboratories across Ghana.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design\u003c/h2\u003e\u003cp\u003eA cross-sectional study was conducted among laboratories in Ghana from May to June 2023.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy Participants\u003c/h3\u003e\n\u003cp\u003eA total of 220 medical laboratories across fourteen (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) regions in Ghana responded to the study. The facilities comprised teaching hospitals, Ghana Health Service (GHS) laboratories, Mission hospitals, Quasi-Government hospitals, and private laboratories. All levels of health facilities with laboratories were included.\u003c/p\u003e\n\u003ch3\u003eEthical Consideration\u003c/h3\u003e\n\u003cp\u003eThe study was approved by the Research Ethics Committee of the Society of Medical Laboratory Managers Ghana and informed consent sought from study respondents. All protocols were conducted in accordance with the Declaration of Helsinki.\u003c/p\u003e\n\u003ch3\u003eSampling\u003c/h3\u003e\n\u003cp\u003eA structured Google questionnaire form was used to collect data using convenience sampling (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://docs.google.com/forms/d/e/1FAIpQLSf4tlwlj_RLsRxfpyIlaNSixyFcCIiwqRww_hC1aa0xGxRY5Q/viewform?usp=sf_link\u003c/span\u003e\u003cspan address=\"https://docs.google.com/forms/d/e/1FAIpQLSf4tlwlj_RLsRxfpyIlaNSixyFcCIiwqRww_hC1aa0xGxRY5Q/viewform?usp=sf_link\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). The form was circulated through regional social media platforms of laboratory professionals in Ghana: Society of Medical Laboratory Managers-Ghana (SMLM-G), Ghana Association of Medical Laboratory Scientists (GAMLS), Association of Private Medical Laboratories (APML). One response was taken per laboratory.\u003c/p\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eThe data stored in MS Excel was analyzed using IBM Statistical Package for Social Sciences (SPSS) version 26. The region of responding facilities stratified by the performance of kidney/renal function tests was presented using a bar graph. Categorical variables were presented in numbers and percentages.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eGeneral characteristics of respondent facilities are described in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. A total of 220 facilities responded to the survey, with majority being GHS facilities (52.7%), and at the district hospital level (41.4%). Approximately 72% of the respondents perform kidney/renal function tests. All the teaching hospitals and quasi-government facilities perform kidney/renal function tests, with GHS having the least number of facilities performing kidney/renal function tests. All the respondent regional hospitals and clinics also conduct kidney/renal function tests. Only 13.2% of health centers conduct such tests. In terms of professional cadres, Consultants/PhDs and Specialists/Masters worked in 63.6% and 87.5% of the facilities that perform kidney/renal function tests respectively. Doctor of medical laboratory science and medical laboratory science graduates also worked in 91.7% and 80.2% of facilities that performed such tests respectively. \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eGeneral characteristics of respondent facilities.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003ePerform KFT/RFT\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;220)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;158 [71.8%])\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;62 [28.2%])\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eType of facility\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTeaching Hospital\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10 (4.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10 (100.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGHS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e116 (52.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e65 (56.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e51 (44.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMission Hospitals\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e39 (17.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e33 (76.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e10 (23.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuasi-Government\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e12 (5.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12 (100.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrivate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e38 (17.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e38 (97.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1 (2.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLevel of facility\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTeaching Hospital\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10 (4.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10 (100.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRegional Hospital\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e14 (6.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14 (100.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDistrict Hospital\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e91 (41.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e72 (79.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e19 (20.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePolyclinic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e27 (12.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17 (63.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e10 (37.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClinic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9 (4.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9 (100.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealth Center\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e38 (17.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5 (13.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e33 (86.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eProfessional Cadres\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eConsultant/PhD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e22 (10.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14 (63.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8 (36.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpecialist/Masters\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e56 (25.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e49 (87.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7 (12.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMLSD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e60 (27.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e55 (91.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5 (8.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMLS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e172 (78.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e138 (80.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e34 (19.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMLT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e150 (68.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e114 (76.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e36 (24.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMLA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e107 (48.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e76 (71.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e31 (29.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cb\u003eKFT: Kidney function test; RFT: Renal function test; MLSD: Doctor of Medical Laboratory Sciences; MLS: Medical Laboratory Scientist; MLT: Medical Laboratory Technician; MLA: Medical Laboratory Assistant\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAbout 32% of facilities reported using the nomenclature \u0026lsquo;kidney function tests (KFT)\u0026rsquo;, 27.2% used \u0026lsquo;renal function tests (RFTs)\u0026rsquo; and 41.1% used both \u0026lsquo;KFT and RFT\u0026rsquo;. About 8% of facilities do not report trace levels of urine protein. Alkaline picrate (Jaffe\u0026rsquo;s) method is used by most of the facilities (61.8%) for creatinine estimation, with enzymatic methods and dry chemistry used by 58.8% and 0.6% respectively. Among those who use the alkaline picrate (Jaffe\u0026rsquo;s) method, about 72% did not know that the method overestimates creatinine levels and 70% did not know about IDMS calibration. Majority of the GHS (74.3%), Missions (69.2%), Quasi-Government (75%) and private (81.8%) facilities did not know of the overestimation by the alkaline picrate (Jaffe\u0026rsquo;s) method. About 67% of the teaching hospitals were aware of the overestimation. With respect to IDMS calibration, majority of all types of facilities had no knowledge about it: 66.7% teaching hospitals, 65.7% GHS, 69.2% Missions, 75% Quasi-Government, and 77.3% private. Most of the facilities reported not knowing whether their creatinine is automatically calibrated to IDMS or not, with 32% reporting their creatinine is calibrated by manufacturer. Only 9% of facilities without automatic calibration to IDMS, corrects creatinine to IDMS standards. \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eKidney or Renal function testing methods to type of facility\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"15\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c15\" colnum=\"15\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTH\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eGHS\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003eMissions\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e\u003cp\u003eQG\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c14\" namest=\"c12\"\u003e\u003cp\u003ePrivate\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"1\" nameend=\"c15\" namest=\"c15\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;158)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;65)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;33)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;12)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c14\" namest=\"c12\"\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;38)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"1\" nameend=\"c15\" namest=\"c15\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eType of Test\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c14\" namest=\"c12\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"1\" nameend=\"c15\" namest=\"c15\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKFT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50 (31.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (20.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e27 (41.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003e6 (18.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e\u003cp\u003e6 (50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c14\" namest=\"c12\"\u003e\u003cp\u003e9 (31.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c15\" namest=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRFT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e43 (27.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (40.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e14 (21.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003e12 (36.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e\u003cp\u003e4 (33.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c14\" namest=\"c12\"\u003e\u003cp\u003e9 (23.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c15\" namest=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKFT \u0026amp; RFT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e65 (41.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (40.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e24 (36.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003e15 (45.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e\u003cp\u003e2 (16.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c14\" namest=\"c12\"\u003e\u003cp\u003e20 (52.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c15\" namest=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eReport trace urine protein\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c12\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c15\" namest=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e145 (91.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9 (90.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e59 (90.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003e33 (100.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e\u003cp\u003e10 (83.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c14\" namest=\"c12\"\u003e\u003cp\u003e34 (89.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c15\" namest=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13 (8.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (10.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e6 (9.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e\u003cp\u003e2 (16.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c14\" namest=\"c12\"\u003e\u003cp\u003e4 (10.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c15\" namest=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCreatinine Estimation Methods\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c12\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c15\" namest=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAlkaline Picrate (Jaffe)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e64 (40.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (20.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e27 (41.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003e15 (45.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e\u003cp\u003e6 (50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c14\" namest=\"c12\"\u003e\u003cp\u003e14 (36.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c15\" namest=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEnzymatic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e59 (37.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (40.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e30 (46.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003e6 (18.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e\u003cp\u003e4 (33.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c14\" namest=\"c12\"\u003e\u003cp\u003e15 (39.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c15\" namest=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJaffe \u0026amp; Enzymatic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e34 (21.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (40.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e8 (12.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003e12 (36.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e\u003cp\u003e2 (16.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c14\" namest=\"c12\"\u003e\u003cp\u003e8 (21.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c15\" namest=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDry Chemistry\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c14\" namest=\"c12\"\u003e\u003cp\u003e1 (2.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c15\" namest=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOverestimation by Jaffe's method\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c12\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c15\" namest=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e27 (27.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (66.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e9 (25.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003e8 (30.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e\u003cp\u003e2 (25.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c14\" namest=\"c12\"\u003e\u003cp\u003e4 (18.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c15\" namest=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e70 (72.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (33.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e26 (74.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003e18 (69.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e\u003cp\u003e6 (75.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c14\" namest=\"c12\"\u003e\u003cp\u003e18 (81.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c15\" namest=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eKnow IDMS\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c14\" namest=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c15\" namest=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e29 (29.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (33.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e12 (34.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003e8 (30.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e\u003cp\u003e2 (25.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c14\" namest=\"c12\"\u003e\u003cp\u003e5 (22.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c15\" namest=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e68 (70.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (66.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e23 (65.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003e18 (69.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e\u003cp\u003e6 (75.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c14\" namest=\"c12\"\u003e\u003cp\u003e17 (77.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c15\" namest=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCreatinine automatically calibrated to IDMS\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c13\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31 (32.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (33.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e9 (25.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003e8 (30.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e\u003cp\u003e3 (37.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c14\" namest=\"c12\"\u003e\u003cp\u003e9 (40.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c15\" namest=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9 (9.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e6 (17.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003e2 (7.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e\u003cp\u003e1 (12.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c14\" namest=\"c12\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c15\" namest=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDo not know\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e57 (58.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (66.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e20 (57.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003e16 (61.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e\u003cp\u003e4 (50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c14\" namest=\"c12\"\u003e\u003cp\u003e13 (59.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c15\" namest=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eManual correction of creatinine to IDMS\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c12\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c15\" namest=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 (9.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (25.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e1 (3.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003e1 (5.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e\u003cp\u003e1 (20.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c14\" namest=\"c12\"\u003e\u003cp\u003e2 (15.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c15\" namest=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e60 (90.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (75.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e25 (96.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003e17 (94.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e\u003cp\u003e4 (80.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c14\" namest=\"c12\"\u003e\u003cp\u003e11 (84.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c15\" namest=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"15\"\u003e\u003cb\u003eTH: Teaching hospital; GHS: Ghana Health Service; QG: Quasi Government; IDMS: Isotope dilution mass spectrometry\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eFor KFT, all the facilities estimate blood urea and blood creatinine tests with 88.7% adding blood electrolytes. Urine dipstick and urine microscopy were examined by 67.8% and 69.6% respectively, and 24-hour urine protein was performed by 12.2%. Urine albumin, albumin-creatinine ratio, and protein-creatinine ratio were analyzed by about 20% of the facilities. Novel markers of blood NGAL, cystatin C, and urine NGAL were estimated by 2.6%, 5.2%, and 1.7% respectively. Approximately 8% perform microalbumin tests. \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eKidney or Renal function tests conducted in laboratories\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eKFT\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRFT\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTests\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;115)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;151)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBlood Urea\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e115 (100.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e151 (100.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBlood Creatinine\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e115 (100.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e150 (99.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBlood Electrolytes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e102 (88.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e133 (88.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBlood NGAL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (2.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (2.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBlood Cystatin C\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 (5.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (2.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUrine Urea\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9 (7.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19 (12.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUrine Albumin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23 (20.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30 (19.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUrine NGAL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (1.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAlbuminuria (Albumin-creatinine ratio)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23 (20.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25 (16.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProteinuria (Protein-creatinine ratio)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22 (19.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21 (13.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMicroalbumin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9 (7.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13 (8.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUrine Dipstick\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e78 (67.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e99 (65.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUrine Microscopy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e80 (69.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e95 (62.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e24-hour urine Protein\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14 (12.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12 (7.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUric Acid\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u003cb\u003eNGAL: Neutrophil gelatinase-associated lipocalin\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eFor RFT, all the facilities estimate blood urea, with 99.3% and 88.15 estimating blood creatinine and blood electrolytes respectively. Urine dipstick and urine microscopy were examined by 65.6% and 62.9% respectively, and 24-hour urine protein was performed by 7.9%. Urine albumin, albumin-creatinine ratio, and protein-creatinine ratio were analyzed by 19.9%, 16.6%, and 13.9% of the facilities respectively. Novel markers of blood NGAL and cystatin C were estimated at 2.6%, and urine NGAL at 0.7%. Approximately 9% perform microalbumin tests as part of RFT. \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e presents the GFR estimation methods used by facilities. Most (48.1%) of the facilities manually estimated GFR, 25.9% is automated and 25.9% does not estimated GFR. For adults, 50.6% use the CKD-EPI formula, 15.2% use Cockcroft-Gault formula, 14.6% use MDRD formula, with 1 facility (0.6%) using the Schwartz formula. Majority of all the facility types also used the CKD-EPI formula. For children, 37.3% use the CKD-EPI formula, 15.8% use Cockcroft-Gault formula, 12.7% use the Schwartz formula and 10.8% use the MDRD formula.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eGFR estimation methods among facilities\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTH\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eGHS\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMissions\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eQG\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003ePrivate\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParameters\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;158)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;65)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;33)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;12)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;38)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003eGFR estimation method\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eManual\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e76 (48.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33 (50.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14 (42.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6 (50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e18 (47.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAutomated\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41 (25.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (20.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10 (15.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9 (27.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5 (41.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e15 (39.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDo not assess GFR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41 (25.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (30.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22 (33.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10 (30.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1 (8.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5 (13.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGFR in adults\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCG\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24 (15.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (10.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14 (21.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5 (15.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4 (10.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMDRD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23 (14.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (10.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9 (13.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3 (9.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1 (8.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e9 (23.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCKD-EPI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e80 (50.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e35 (53.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e18 (54.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7 (58.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e17 (44.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSchwartz\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (1.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGFR in children\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCG\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25 (15.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (10.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13 (20.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6 (18.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5 (13.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMDRD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17 (10.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (10.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6 (9.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3 (9.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e7 (18.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCKD-EPI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e59 (37.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (20.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e28 (43.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13 (9.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3 (25.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e13 (34.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSchwartz\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20 (12.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (10.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8 (12.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4 (12.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3 (25.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4 (10.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot estimated\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 (3.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (3.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1 (3.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1 (8.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2 (5.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003cb\u003eCKD-EPI: Chronic Kidney Disease Epidemiology Collaboration\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAbout 80% of the facilities reported using GFR to diagnose and stage CKD. Approximately 33% and 27% used urine dipstick and urine microscopy respectively. Albuminuria was used by 19%, proteinuria by 19.6% and microalbumin by 7.6% of the facilities. Only 0.6% used creatinine alone and it was a GHS facility. For AKI diagnosis and staging, majority (44.9%) of the facilities reported not receiving requests for AKI diagnosis, with 8.9% using no guideline. For those who receive request most of the facility types used BUE/Cr ratio, except quasi-government facilities which majority did not use any guideline. AKIN, RIFLE and KDIGO criteria were used by 1.9%, 4.4% and 5.7% of all the facilities respectively. Creatinine was the commonest test performed for AKI diagnosis (47.5%). GFR was estimated by 44.3% and BUN/Cr by 36.1%. Urine dipstick and urine microscopy were performed by 29.7% and 26.6% respectively. Only 11.4% examined 24-hour urine. NGAL and Cystatin C were the least common tests performed (1.9% and 4.4% respectively). Creatinine was the commonest test by most facility types except Missions and Quasi Governement facilities where majority performed GFR. \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCKD and AKI diagnosis with type of facility\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"13\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eTH\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003eGHS\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003eMissions\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003eQG\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e\u003cp\u003ePrivate\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParameters\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;158)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;65)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;33)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;12)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;38)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003eCKD Diagnosis and Staging\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"1\" nameend=\"c13\" namest=\"c13\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCreatine alone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1 (0.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e1 (1.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGFR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e127 (80.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e8 (80.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e48 (73.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e27 (81.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e10 (83.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e\u003cp\u003e34 (89.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAlbuminuria\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e30 (19.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e3 (30.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e8 (12.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e7 (21.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e2 (16.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e\u003cp\u003e10 (26.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProteinuria\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e31 (19.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e3 (30.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e12 (18.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e7 (21.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e3 (25.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e\u003cp\u003e6 (15.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMicroalbumin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e12 (7.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e2 (20.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e3 (4.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e3 (9.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e1 (8.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e\u003cp\u003e3 (7.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUrine Dipstick\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e52 (32.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e4 (40.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e16 (24.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e14 (42.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e6 (50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e\u003cp\u003e12 (31.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUrine Microscopy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e42 (26.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e2 (20.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e13 (20.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e12 (36.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e4 (33.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e\u003cp\u003e11 (28.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAKI Diagnosis and Staging\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c13\" namest=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAKIN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e3 (1.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e2 (20.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e\u003cp\u003e1 (2.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRIFLE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e7 (4.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e2 (20.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e3 (4.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e2 (6.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKDIGO\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e9 (5.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e2 (20.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e2 (3.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e1 (3.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e1 (8.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e\u003cp\u003e3 (7.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBUN/Cr\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e57 (36.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e5 (50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e19 (29.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e13 (39.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e2 (16.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e\u003cp\u003e18 (47.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGFR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1 (0.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e1 (1.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo guideline\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e14 (8.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e4 (6.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e6 (18.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e3 (25.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e\u003cp\u003e1 (2.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo request\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e71 (44.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e2 (20.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e36 (55.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e11 (33.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e6 (50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e\u003cp\u003e16 (42.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTests for AKI\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c13\" namest=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCreatinine\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e75 (47.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e7 (70.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e30 (46.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e12 (36.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e6 (50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e\u003cp\u003e20 (52.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGFR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e70 (44.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e4 (40.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e29 (44.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e15 (45.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e7 (58.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e\u003cp\u003e15 (39.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e24-hour urine\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e18 (11.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e1 (10.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e8 (12.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e4 (12.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e2 (16.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e\u003cp\u003e3 (7.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBUN/Cr\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e53 (33.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e3 (30.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e28 (43.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e9 (27.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e1 (8.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e\u003cp\u003e12 (31.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUrine Dipstick\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e47 (29.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e3 (30.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e19 (29.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e8 (24.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e4 (33.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e\u003cp\u003e13 (34.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUrine Microscopy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e42 (26.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e2 (20.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e17 (26.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e7 (21.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e2 (16.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e\u003cp\u003e14 (36.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCystatin C\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e7 (4.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e2 (20.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e4 (6.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e\u003cp\u003e1 (2.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNGAL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e3 (1.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e1 (10.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e1 (8.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e\u003cp\u003e1 (2.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eKidney diseases are a major cause of morbidity and mortality worldwide. The ascendance in the incidence of non-communicable and infectious diseases in developing countries like Ghana is associated with a high risk for kidney diseases (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). This study examined the knowledge and kidney function testing practices among medical laboratories in Ghana.\u003c/p\u003e\u003cp\u003eIn resource-limited countries, the true estimates of kidney diseases may be precluded by inadequate health infrastructure and resources for diagnosis. In this study, although all the teaching hospitals and regional hospitals perform kidney/renal function tests, only 79.1% of district hospitals perform such tests. This might affect effective diagnosis as well as management of affected patients since it is more convenient to access district hospitals than regional or teaching hospitals by the majority of the populace due to distance and economic reasons.\u003c/p\u003e\u003cp\u003eThere lacks a uniform and clear nomenclature for tests assessing kidney function in Ghana with some facilities using either kidney function tests (KFT) or renal function tests (RFTs) or both. Others also use the term blood urea electrolytes and creatinine (BUE \u0026amp; Cr) to refer. This has led to different parameters being examined depending on the nomenclature used. The Kidney Disease Improving Global Outcomes (KDIGO) group recommends that terminologies used in describing kidney function and disease should be uniform and easily understood, irrespective of an individual\u0026rsquo;s level of health literacy (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). A coherent, shared nomenclature would ensure effective communication at all levels, efficient comparison and integration of datasets, and enable better recognition of gaps in knowledge for future research.\u003c/p\u003e\u003cp\u003eA daily excretion of more than 300 mg of protein is referred to as Proteinuria. Normal daily excretion is 150 mg. A urine dipstick detects minute urine protein levels between 100 to 200 mg per day as \u0026ldquo;trace\u0026rdquo; (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Hence, reporting trace urine dipstick protein can help identify early leakage of proteins in urine. Although the majority of laboratories in the study report trace urine dipstick protein results, others did not. Laboratories should, therefore, report trace urine dipstick protein results for early identification of kidney abnormalities.\u003c/p\u003e\u003cp\u003eCreatinine estimations must have a minimal total error to ensure that bias in estimated GFR remains within clinically acceptable limits (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). The methods mostly used to estimate serum creatinine among laboratories in Ghana are alkaline picrate (Jaffe) methods and enzymatic assays, with the Jaffe being the most common. The presence of interfering substances results in the overestimation of serum creatinine by 15\u0026ndash;25% when the Jaffe method is used. For instance, glucose and acetoacetate are major causes of falsely elevated creatinine in people living with diabetes mellitus with a high risk of developing CKD (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). However, among the respondent facilities that used the alkaline picrate (Jaffe\u0026rsquo;s) method, a higher proportion (72%) did not know that the method overestimates creatinine levels. To overcome the limitations of creatinine estimation, it is recommended that in vitro diagnostic (IVD) manufacturers calibrate serum creatinine methods to be traceable to isotope dilution mass spectrometry (IDMS), or manually corrected (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Most of the facilities in this study did not know about IDMS calibration, with the majority not knowing whether their creatinine is automatically calibrated to IDMS or not. Only a few had their creatinine calibrated by the manufacturer or corrected their creatinine to IDMS standards. There is the need for scientists to ensure creatinine measurements are calibrated to IDMS standards and Jaffe results corrected. Regular refresher training on kidney function tests and their limitations is therefore needed for laboratory professionals.\u003c/p\u003e\u003cp\u003eThe best marker for examining the function of the glomerulus is the glomerular filtration rate (GFR) (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). GFR is mostly estimated using serum concentrations of blood creatinine or cystatin C, with different GFR estimating equations proposed (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). MDRD equation, though more reliable than the Cockcroft-Gault equation, has been reported to be imprecise (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Studies conducted in Ghana found the CKD-EPI equation to perform better than other equations for estimating glomerular function (\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). For adults, about half of the laboratories used the CKD-EPI formula, with few using the Cockcroft-Gault and MDRD formulas. Only one facility used the Schwartz formula. These equations were developed and validated in an adult population. Also, variations in creatinine calibration and imprecise methods have a significant effect on estimating GFR in children, who usually have lower serum creatinine levels. Hence, the Schwartz and the Counahan\u0026ndash;Barratt equations have been recommended in children (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). In this study, a majority used the CKD-EPI formula followed by the Cockcroft-Gault formula. Only a few (12.7%) used the Schwartz formula.\u003c/p\u003e\u003cp\u003eCKD is diagnosed in the laboratory by decreased GFR or markers of kidney damage such as albuminuria or urine sediment abnormalities (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Majority of the facilities use GFR to diagnose and stage CKD. Guidelines such as RIFLE, AKIN, and KDIGO have been developed to aid the diagnosis of AKI. The KDIGO AKI guideline integrates the recommendation by RIFLE and AKIN making it the most widely used currently (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). For AKI diagnosis and staging, the majority of the facilities do not receive requests for AKI diagnosis. For those who received requests, most of the facility types used the BUE/Cr ratio. AKIN, RIFLE, and KDIGO criteria were each used by very few facilities. The KDIGO AKI guidelines combine GFR or serum creatinine and 24-hour urine output in diagnosing and classifying the disorder (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). However, less than half of the facilities in this study used creatinine or GFR for AKI diagnosis. The use of both the blood creatinine and the urine output is more accurate than the measurement of creatinine alone due to the delay in the rise of creatinine after injury (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eUrine dipstick and urine microscopy were performed by less than one-third of facilities, with few examining 24-hour urine. Different urine cells, crystals, and casts have been associated with prerenal azotemia and acute tubular necrosis (ATN). (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Hence, urine microscopy can help distinguish these conditions when combined with clinical history. Also, urine microscopy can help detect rare causes of AKI. The finding of significant hematuria, pyuria without bacteriuria, and cellular casts is observed in glomerulonephritis (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Pyuria without bacteriuria and/or white blood cell casts is indicative of acute interstitial nephritis (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eCreatinine is a less sensitive marker and can take 24 to 40 hours to increase in response to kidney injury (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Hence, there has been a search for an early biomarker. Cystatin C has been proposed as a biomarker for earlier detection of changes in kidney function. However, most forms of AKI primarily involve injury in the kidney tubular epithelium, so a decrease in GFR alone (as measured by cystatin C) is not a sensitive or early indicator (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Several new AKI biomarkers have been approved for use in humans in different countries, such as TIMP-2*IGFBP7, NGAL, IL-18, etc (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). The Acute Dialysis Quality Initiative (ADQI) group recommends a combination of damage (NGAL) and functional biomarkers (cystatin C), along with clinical information to improve the diagnostic accuracy of AKI, to recognize the different pathophysiological processes, to discriminate AKI etiology, and to assess AKI severity. Other studies have also reported the stress biomarker, TIMP-2*IGFBP7, to predict early AKI in at-risk individuals (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). However, NGAL and Cystatin C were the least common tests performed by laboratories in this study. The inclusion of traditional markers like fractional excretion of sodium or urea, BUE/Cr ratio, and urinalysis in kidney function testing would aid identification of the cause of AKI. A combination of NGAL, cystatin C, and clinical history can be used to improve the diagnostic accuracy of AKI, identify the etiology, and assess disease severity where applicable.\u003c/p\u003e\u003cp\u003eThough this is the study first study to assess kidney function testing practices among laboratories in Ghana to the best of our knowledge, it is limited by the use of only online questionnaires for data collection without site inspection by researchers.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eKidney function testing was performed by most laboratories, but not all district hospitals conducted the test. Knowledge of the limitations of creatinine measurements and standardization was low. Also, GFR estimation as well as AKI and CKD diagnostic practices was inadequate. We recommend that nationwide training should be organized for scientists on kidney function tests and their limitations. A proficiency testing program needs to be instituted to ensure the accuracy and reliability of results from various laboratories in the country. Furthermore, a national guideline on kidney function testing is needed.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eIDMS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eIsotope dilution mass spectrometry\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCKD-EPI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eChronic Kidney Disease Epidemiology Collaboration\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eMDRD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eModification of Diet in Renal Disease\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eAKIN\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAcute Kidney Injury Network\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eRIFLE\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eRisk Injury Failure Loss End-stage\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eKDIGO\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eKidney Disease:Improving Global Outcomes\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCKD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eChronic Kidney Disease\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eAKI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAcute Kidney Injury\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eGHS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eGhana Health Service\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eKFT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eKidney function test\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eRFT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eRenal Function test\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eNGAL\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eNeutrophil gelatinase-associated lipocalin\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eGFR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eGlomerular filtration rate\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eTH\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eTeaching Hospital\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eQG\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eQuasi Government Hospital\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eATN\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAcute tubular necrosis\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eTIMP2\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eTissue Inhibitor metalloproteinase 2\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eIGFBP7\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eInsulin-like growth factor binding protein 7\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eApproval was sought from the Research Ethics Committee of the Society of Medical Laboratory Managers-Ghana, and the Ghana Association of Medical Laboratory Scientists (GAMLS) before commencing the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConsent for publication was sought from participating laboratories\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used in the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that there are no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was self-financed by authors\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePA: Conception and design of the study, data collection and analysis, drafting of the manuscript; ED: Conception and design of the study, data collection and analysis, drafting of the manuscript; ET: Data collection and analysis, drafting of the manuscript; SA: Data collection and analysis, drafting of the manuscript; IA: Data collection and analysis, drafting of the manuscript; FAA: Data collection and analysis, drafting of the manuscript; WT: Data collection and analysis, drafting of the manuscript; MAB: Data collection and analysis, drafting of the manuscript; DSS: Data collection and analysis, drafting of the manuscript; TA: Data collection and analysis, drafting of the manuscript; RKDE: Conception and design of the study, data collection and analysis, drafting of the manuscript. All authors reviewed and approved the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe acknowledge the contributions of the regional and national executives of the Society of Medical Laboratory Managers-Ghana, and the Ghana Association of Medical Laboratory Scientists (GAMLS) during the data collection.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGounden, V., Bhatt, H. \u0026amp; Jialal, I. Renal function tests. In: StatPearls. Treasure Island (FL): StatPearls Publishing. :1\u0026ndash;9. (2023).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJadoul, M. et al. 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Tissue inhibitor metalloproteinase 2 (TIMP-2) and insulin-like growth factor binding protein 7 (IGFBP7) best predicts the development of acute kidney injury. \u003cem\u003eHeliyon\u003c/em\u003e \u003cb\u003e7\u003c/b\u003e, e07960 (2021).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Kidney function test, renal function test, kidney disease, medical laboratories","lastPublishedDoi":"10.21203/rs.3.rs-7175283/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7175283/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eKidney function is assessed to detect kidney diseases and help manage individuals with kidney diseases or pathologies that impair the function of the kidneys. Better diagnostic methods that enable early detection of kidney diseases are vital for reversing the disorders in the early stages. This would ultimately prevent progression to advanced stages with significant economic burden and a negative impact on quality of life. This study examined the kidney function testing practices among medical laboratories in Ghana.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA structured Google questionnaire form was conveniently used to collect data from 220 medical laboratories across fourteen (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) regions in Ghana.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eAll the teaching hospitals and regional hospitals carry out kidney/renal function tests, with only 79.1% of district hospitals performing such tests. There was no standard nomenclature for such tests. The alkaline picrate (Jaffe\u0026rsquo;s) method is used by most of the facilities (61.8%) for creatinine estimation, with enzymatic methods used by 58.8%. Most of the facilities did not know whether their creatinine is automatically calibrated to isotope dilution mass spectrometry (IDMS) or not, with 32% reporting their creatinine is calibrated by the manufacturer. Only 9% of facilities correct their creatinine values. For the Glomerular filtration rate (GFR) estimation, 50.6% use the CKD-EPI formula, 15.2% use the Cockcroft-Gault formula, and 14.6% the use MDRD formula in adults. For children, a majority (37.3%) use the CKD-EPI formula, 15.8% use the Cockcroft-Gault formula, 12.7% use the Schwartz formula and 10.8% use the MDRD formula. AKIN, RIFLE, and KDIGO criteria were each used by \u0026lt;\u0026thinsp;6% of the facilities.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eWe recommend that nationwide training, with a well-developed national guideline on kidney function testing, should be organized for scientists on kidney function tests and their limitations.\u003c/p\u003e","manuscriptTitle":"Evaluation of Kidney Function Testing Practices among Medical Laboratories in Ghana","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-02 06:57:25","doi":"10.21203/rs.3.rs-7175283/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"299598b6-a6cb-46ff-acc1-d40d99d3c716","owner":[],"postedDate":"September 2nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":53808495,"name":"Health sciences/Diseases"},{"id":53808496,"name":"Health sciences/Health care"},{"id":53808497,"name":"Health sciences/Medical research"},{"id":53808498,"name":"Health sciences/Nephrology"}],"tags":[],"updatedAt":"2025-10-27T13:59:07+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-02 06:57:25","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7175283","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7175283","identity":"rs-7175283","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}