Reliable quantification of renal function from frozen blood samples

BACKGROUND: Differences in renal function may affect Alzheimer disease (AD) blood biomarker levels independent of AD pathology. Although renal function was unaccounted for in foundational AD blood biomarker studies, there is potential to address this through quantification of estimated glomerular filtration rate (eGFR) from frozen serum and plasma samples. However, the validity of eGFR evaluation from long-term frozen blood samples is unknown. METHODS: Adults aged 50-85 with at least 2 vascular risk factors were recruited from vascular surgery or cardiology clinics in Tucson, Arizona from 2022-2025. Individuals with creatinine assessments in point-of-care whole blood (POC-WB) and frozen serum and plasma samples using the iSTAT (Abbott) were included. eGFR was calculated using the 2021 CKD-EPI creatinine equation without race. Agreement between POC-WB and frozen blood samples was assessed using Cohen's kappa with linear weights. RESULTS: 134 participants (mean [SD] age: 72.6 [7.5] years, 39.6% female, 23.1% chronic kidney disease) had POC-WB eGFR available. Frozen serum and plasma samples had strong agreement with POC-WB for eGFR (Kw= 0.90-0.95, P<0.001). Pre-analytical factors had minimal effect on eGFR differences between POC-WB and frozen blood samples. CONCLUSIONS: Renal function can be assessed from frozen blood samples with high consistency to POC-WB, which may be particularly relevant for interpretation of AD blood biomarkers in general aging and vascular populations who often have impaired renal function.