Limiting the testing of urea: Urea along with every plasma creatinine test?

We found that it is not necessary to simultaneously detect both creatinine (CREA) and urea until the concentration of CREA is lower than the certain level. To reduce urea testing, we suggest measuring urea only when CREA or estimated glomerular filtration rate (eGFR) exceeds a predetermined limit.

CREA and urea data were analyzed consisting of almost all of people age above 65 years old check-up (n=95441) in Shuyang countryside, and inpatients (n=101631), outpatients (n=18474) and Routine Health Check-up (n=20509) in Shuyang People's Hospital. The proportions of elevated urea were derived. The data used in this study was generated from people more than 13 years old in both outpatients and inpatients.

When the limits for initiating urea testing were used at 85 μmol/L CREA and 120 mL/min/1.73 m² eGFR, the percentage of unnecessary urea test are 94.5% and 64.7% (elderly health check-up), 67.9% and 84.5% (outpatients), 88.5% and 73.2% (inpatients), 92.2% and 81.7% (routine health check-up). The missing rate of urea are 1%, 2.5%, 4.6% and 9.2%, 0.1%, 0.4%, 0.9% and 1.8%, 0.4%, 0.8%, 1.4%, and 2.5%, 0.05%, 0.1%, 1.1%, and 0.8% of ureas exceeding 9.28 mmol/L and 8.3 mmol/L in above each group, respectively. If the CREA≤85 μmol/L or eGFR≥90 mL/min/1.73 m² , there is 97.5% urea <10.1 mmol/L, the proportion of elevated urea missed is 2.5%.

We suggest that the initiating urea testing should be based on the upper limit of Reference Intervals serum CREA of females or a 120 mL/min/1.73 m² eGFR limit. Conservatively, the urea testing would be reduced by 65% at least.