Creatinine clearance in renal disease. A reappraisal

Kim, Kwan E.; Onesti, Gaddo; Ramirez, Osvaldo; Brest, Albert N.; Swartz, Charles

doi:10.1136/bmj.4.5674.11

Cited by 130 publications

(50 citation statements)

References 14 publications

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“…Second, the study did not include information on the concomitant use of drugs, such as trimethoprim or cimetidine (43,44), which can inhibit the tubular secretion of creatinine, although the use of these medications is likely to be rare at the time period of CRIC enrollment. Our results are consistent with prior studies which have reported that CrCl is approximately 10%-30% higher than simultaneously measured GFR (16)(17)(18)(19)45). Third, since there was only one measurement of baseline iGFR and CrCl, we were not able to generate data on within-person CV from CRIC data and had to rely on data from previously published studies.…”

Section: Discussionsupporting

confidence: 80%

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Measurement Error as Alternative Explanation for the Observation that CrCl/GFR Ratio is Higher at Lower GFR

Zhang

McCulloch

Lin

et al. 2016

CJASN

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Background and objectives Overestimation of GFR by urinary creatinine clearance (CrCl) at lower levels of GFR has long been attributed to enhanced creatinine secretion. However, this does not take into consideration the contribution of errors in measured GFR (and CrCl) due to short-term biologic variability or test imprecision.Design, setting, participants, & measurements We analyzed cross-sectional data among 1342 participants from the Chronic Renal Insufficiency Cohort study with baseline measurement of GFR by iothalamate clearance (iGFR) and CrCl by 24-hour urine collection. We examined the CrCl/iGFR ratio classified by categories of iGFR and also by categories of CrCl.Results Overall, mean CrCl/iGFR ratio was 1.13. CrCl/iGFR ratio was higher at lower iGFR categories. In contrast, this ratio was lower at lower CrCl levels. We hypothesize these relationships could be due to measurement error, which is bolstered by replicating these trends in a simulation and modeling exercise in which there was no variation in the ratio of CrCl/iGFR with true kidney function but taking into account the effect of measurement error in both CrCl and iGFR (of magnitudes previously described in the literature). In our simulated data, the observed CrCl/iGFR ratio was higher at lower observed iGFR levels when patients were classified by categories of observed iGFR. When the same patients were classified by categories of observed CrCl, the observed CrCl/iGFR ratio was lower at lower observed CrCl levels. ConclusionsThe combined empirical and modeling results suggest that measurement errors (in both CrCl and iGFR) should be considered as an alternative explanation for the longstanding observation that the ratio of CrCl to iGFR gets larger as iGFR decreases.

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Section: Discussionsupporting

confidence: 80%

“…However, available empirical data supporting this notion primarily consist of studies showing that the CrCl/GFR ratio is higher in patients with lower measured GFR than in patients with higher measured GFR (Supplemental Table 1) (16)(17)(18)(19)(20).…”

mentioning

confidence: 99%

Measurement Error as Alternative Explanation for the Observation that CrCl/GFR Ratio is Higher at Lower GFR

Zhang

McCulloch

Lin

et al. 2016

CJASN

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“…genous creatinine clearance is an inaccurate estimate of GFR (Miller et al, 1952;teen restricted. Examples of the use of inulin Berlyne et al, 1964; in drug studies can be found in the papers of Kim et al, 1969;Skov, 1970;Hagstam et al, 1974).…”

Section: Inulin Clearancementioning

confidence: 99%

Glomerular filtration rate and creatinine clearance.

Jp¹,

Hansen²

1981

Brit J Clinical Pharma

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“…All these factors could explain why serum creatinine is not a good biomarker to estimate the GFR correctly. 6 Therefore, the need for new biomarkers has increased in recent years. 7 In this sense, cystatin C and neutrophil gelatinase-associated lipocalin (NGAL) are two of early promising biomarkers.…”

Section: Introductionmentioning

confidence: 99%

The efficacy of theophylline in preventing cisplatin-related nephrotoxicity in patients with cancer

et al. 2016

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Objective: Cisplatin is a potent antineoplastic agent used and its major limiting side effect is nephrotoxicity. The aims of the study are early detection of acute kidney injury (AKI) with biomarkers and investigation of the potential nephron-protective effects of theophylline. Methods: Glomerular filtration rates (GFR), neutrophil gelatinase-associated lipocalin (NGAL), cystatin C were measured at 5th day of treatment in all of the patients. In addition, these parameters were measured repeatedly after the administration of cisplatin, at 2nd hour, 5th and 20th days. Patients: Sixty patients who are planned to receive cisplatin for the first time were included in the study. Patients were divided into two groups as Group 1 (n ¼ 30) (standard treatment arm) and Group II (n ¼ 30) (theophylline arm). Results: In both groups after the administration of cisplatin, GFR showed a significant decrease within time (p ¼ 0.006). Urine NGAL levels were significantly high after 2 h of cisplatin administration (p < 0.001), no significant difference was observed between groups. However, when the time*group effects were considered together, higher NGAL levels were detected in the group not receiving theophylline (p ¼ 0.025). After 5 days of cisplatin administration, urine protein levels were significantly higher in both groups (p < 0.001). Conclusion: Results showed that urine NGAL level is a superior biomarker compared to serum creatinine and serum cystatin C in the detection of early AKI. Theophylline was found not to bring a complete protection for the kidneys, but less nephrotoxicity was developed when compared to the group not receiving theophylline. ARTICLE HISTORY

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Creatinine clearance in renal disease. A reappraisal

Cited by 130 publications

References 14 publications

Measurement Error as Alternative Explanation for the Observation that CrCl/GFR Ratio is Higher at Lower GFR

Measurement Error as Alternative Explanation for the Observation that CrCl/GFR Ratio is Higher at Lower GFR

Glomerular filtration rate and creatinine clearance.

The efficacy of theophylline in preventing cisplatin-related nephrotoxicity in patients with cancer

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