#360 Renal function assessment with point of care creatinine and potassium in diverse populations (RAPID study): An interim analysis

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Abstract Background and Aims Point-of-care (POC) testing enhances care through rapid turnaround times, instant-decision making and improving patient engagement. With rising incidence of chronic kidney disease (CKD), early diagnosis and timely management with POC testing may be essential to reduce adverse cardiovascular and renal outcomes. This study aims to investigate the agreement of two POC devices compared to laboratory reference methods for creatinine and potassium concentrations in a large diverse cohort (RAPID study; IRAS 263206). Method A prospective cross-sectional cohort study, for adults with and without CKD, including people from ethnic minority backgrounds. Capillary and venous samples using NovaMax (NovaBiomedical) POC-creatinine (POC-Cr) and the Epoc-Blood-Analysis-System (Siemens Healthineers) POC-Cr and POC-potassium (POC-K) were compared to laboratory measured serum creatinine and potassium concentrations. eGFR was calculated using the CKD-EPI 2009 equation without ethnicity co-efficient. Agreement was assessed using bias and concordance correlation co-efficient (CCC) with 95% confidence intervals (CI). Sensitivity and specificity for CKD identification (eGFR < 60 mL/min/1.73 m2) and in-range potassium (3.50-5.49 mmol/L) were calculated for POC capillary and venous samples. Results 279 participants were recruited; 172 (61.6)% male, mean age 57.6 ± 14.5 years. Over half of participants were of non-white self-reported ethnicities. Demographics and renal characteristics are summarised in Table 1. Compared to lab-Cr, capillary POC-Cr Novamax (N = 93) median bias 21 (IQR −5.2–55.3) micromol/L and CCC 0.88 (95% CI: 0.82–0.91); capillary Epoc (N = 68) had a median bias of −10.5 (−19–−2.75) micromol/L and CCC 0.91 (95% CI: 0.88–0.95). Venous POC-Cr for NovaMax (N = 133) had median bias of 27.4 (0.2, 59.4) micromol/L and CCC 0.84 (95% CI: 0.79–0.88); Epoc (N = 248) had median bias of −8 (−18, 0) micromol/L, CCC 0.99 (95% CI 0.99–0.99). There was significant reduction in creatinine bias with the Novamax device for people without CKD (eGFR ≥60) compared to those with CKD for capillary (P < 0.001) and venous (P = 0.009) samples but no significant difference in bias with the Epoc device according to CKD status (capillary: P = 0.60; venous: P = 0.08). Compared to lab-eGFR, capillary POC-eGFR Novamax (N = 93) had a median bias of −3.46 (95% CI: −9.46–1.44) mL/min/1.73 m² and CCC 0.89 (95% CI: 0.83–0.92). Capillary Epoc (N = 68) showed a median bias of 2.6 (95% CI: 0.26–8.26) mL/min/1.73 m² and CCC 0.92 (95% CI: 0.88–0.95). Venous POC-eGFR for NovaMax (N = 133) had a median bias of −4.9 (95% CI: −10.29–−0.12) mL/min/1.73 m² and CCC 0.90 (95% CI: 0.86–0.93). Venous Epoc (N = 248) median bias was 1.86 (95% CI: 0–4.63) mL/min/1.73 m² and CCC 0.96 (95% CI: 0.96–0.97). There was no significant difference in creatinine bias between Black, White and South Asian ethnicity groups (P = 0.148). Novamax capillary and venous samples had the highest sensitivity for detecting CKD (eGFR ≥60; 95.1% and 94.9%) but lower specificity (75.0% and 81.3%). Epoc capillary and venous samples had lower sensitivity (78.6% and 89.7%) with high specificity (100% and 97.1%). Capillary and venous potassium samples for Epoc device showed a mean bias of 0.22 ± 0.48 mmol/L (CCC 0.67; 95% CI 0.54–0.76) and −0.18 ± 0.25 mmol/L (CCC 0.84; 95% CI 0.81–0.88) respectively. Capillary samples sensitivity and specificity for potassium (3.50–5.49 mmol/L) were 86.1% and 100%; venous were 97.8% and 47.4% respectively. Conclusion Both devices demonstrated a strong positive correlation with creatinine / eGFR and have potential to be utilised in clinical settings, with comparable performance of capillary and venous blood sampling. POC-Cr implementation for diagnosis and management of CKD requires consideration of requirements of test performance weighed against user-friendliness and cost. Capillary Epoc POC-K had high specificity which has reassuring clinical safety implications for monitoring patients with CKD.

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