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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

Editor-in-Chief: Plebani, Mario

Ed. by Gillery, Philippe / Greaves, Ronda / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Payne, Deborah A. / Schlattmann, Peter

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Volume 57, Issue 6


Lower creatinine concentration values and lower inter-laboratory variation among Swedish hospital laboratories in 2014 compared to 1996: results from the Equalis external quality assessment program

Johanna Helmersson-Karlqvist
  • Corresponding author
  • Department of Medical Sciences, Clinical Chemistry, Uppsala University Hospital, Uppsala, Sweden
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Peter Ridefelt
  • Department of Medical Sciences, Clinical Chemistry, Uppsala University Hospital, Uppsala, Sweden
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Elisabet Eriksson Boija / Gunnar Nordin
Published Online: 2019-04-15 | DOI: https://doi.org/10.1515/cclm-2018-0670



Creatinine measurement for estimation of glomerular filtration rate (GFR) is a frequently used laboratory test. Differences in analytic creatinine methods have caused large inter-laboratory variation. International and national standardization efforts have been made in the last decade.


This study describes the results of the standardization efforts in Sweden by summarizing data for creatinine concentration in blood plasma in the Equalis quality assessment program during 1996–2014.


Non-compensated Jaffe methods dominated in 1996–2001 (91 of 103 laboratories; 90%) and were then gradually replaced by either compensated Jaffe methods or enzymatic creatinine methods. In 2014 a majority of Swedish hospital laboratories (139 of 159; 87%) used enzymatic methods. The reported mean creatinine value by the Swedish laboratories was about 10 μmol/L higher than the isotope dilution mass spectrometry (IDMS) assured reference value in 2003, but consistent with the reference value from 2009 to 2014. The inter-laboratory CV was 7%–9% for creatinine values until 2007, and thereafter gradually decreased to about 4%–5% in 2014.


The introduction of enzymatic methods in Swedish laboratories has contributed to achieving a low inter-laboratory variation. Also, the reported values are lower for enzymatic methods compared to Jaffe methods, and the values obtained with enzymatic methods were consistent with IDMS certified values established at reference laboratories. Thus, many Swedish hospital laboratories reported 10 μmol/L lower, and more true, creatinine concentrations in 2012 than in 2003, which may cause bias in longitudinal studies.

Keywords: creatinine methods; external quality assessment; harmonization; inter-laboratory variation; standardization


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About the article

Corresponding author: Johanna Helmersson-Karlqvist, MD, PhD, Department of Medical Sciences, Clinical Chemistry, Uppsala University Hospital, 751 85 Uppsala, Sweden, Phone: +46-18-6114228, Fax: +46-18-552562

Received: 2018-06-26

Accepted: 2018-10-18

Published Online: 2019-04-15

Published in Print: 2019-05-27

Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

Research funding: None declared.

Employment or leadership: None declared.

Honorarium: None declared.

Competing interests: The funding organization played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

Citation Information: Clinical Chemistry and Laboratory Medicine (CCLM), Volume 57, Issue 6, Pages 838–844, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: https://doi.org/10.1515/cclm-2018-0670.

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