Estimating GFR prior to contrast medium examinations—what the radiologist needs to know!

Nyman, Ulf; Björk, Jonas; Bäck, Sven; Sterner, Gunnar; Grubb, Anders

doi:10.1007/s00330-015-3842-9

Cited by 7 publications

(5 citation statements)

References 84 publications

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“…Cystatin C, produced at a constant rate by human nucleated cells, is freely filtered, not actively secreted, or dependent on muscle mass or diet (Nyman et al, 2015). Equations combining serum cystatin C and creatinine have been proposed to provide a more accurate estimate of GFR (Inker et al, 2012).…”

Section: Markers Of Renal Functionmentioning

confidence: 99%

The Complexities of Interpreting Reversible Elevated Serum Creatinine Levels in Drug Development: Does a Correlation with Inhibition of Renal Transporters Exist?

Chu

Bleasby

Chan

et al. 2016

Drug Metabolism and Disposition

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In humans, creatinine is formed by a multistep process in liver and muscle and eliminated via the kidney by a combination of glomerular filtration and active transport. Based on current evidence, creatinine can be taken up into renal proximal tubule cells by the basolaterally localized organic cation transporter 2 (OCT2) and the organic anion transporter 2, and effluxed into the urine by the apically localized multidrug and toxin extrusion protein 1 (MATE1) and MATE2K. Druginduced elevation of serum creatinine (SCr) and/or reduced creatinine renal clearance is routinely used as a marker for acute kidney injury. Interpretation of elevated SCr can be complex, because such increases can be reversible and explained by inhibition of renal transporters involved in active secretion of creatinine or other secondary factors, such as diet and disease state. Distinction between these possibilities is important from a drug development perspective, as increases in SCr can result in the termination of otherwise efficacious drug candidates. In this review, we discuss the challenges associated with using creatinine as a marker for kidney damage. Furthermore, to evaluate whether reversible changes in SCr can be predicted prospectively based on in vitro transporter inhibition data, an in-depth in vitro-in vivo correlation (IVIVC) analysis was conducted for 16 drugs with in-house and literature in vitro transporter inhibition data for OCT2, MATE1, and MATE2K, as well as total and unbound maximum plasma concentration (C max and C max,u ) data measured in the clinic.

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Section: Markers Of Renal Functionmentioning

confidence: 99%

The Complexities of Interpreting Reversible Elevated Serum Creatinine Levels in Drug Development: Does a Correlation with Inhibition of Renal Transporters Exist?

Chu

Bleasby

Chan

et al. 2016

Drug Metabolism and Disposition

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“…patients with abnormal muscle mass or liver failure. In such patients, a cystatin C–based equation or clearance measurements may be preferable [ 14 ].…”

Section: Contrast Medium Dose/gfr Ratiomentioning

confidence: 99%

“…GFR may be measured (mGFR) indirectly by analyzing plasma or renal clearance of externally injected biomarkers [ 12 , 13 ], but is not practical to use in a busy daily radiology practice. Instead, GFR may be estimated (eGFR) using equations based on plasma/serum creatinine, cystatin C or both [ 1 , 14 ]. Both mGFR and eGFR may be expressed in absolute terms, mL/min, or adjusted to body surface area (BSA), relative GFR in mL/min/1.73 m 2 .…”

Section: Introductionmentioning

confidence: 99%

Absolute and relative GFR and contrast medium dose/GFR ratio: cornerstones when predicting the risk of acute kidney injury

et al. 2023

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Glomerular filtration rate (GFR) is considered the best overall index of kidney function in health and disease and its use is recommended to evaluate the risk of iodine contrast medium-induced acute kidney injury (CI-AKI) either as a single parameter or as a ratio between the total contrast medium dose (gram iodine) and GFR. GFR may be expressed in absolute terms (mL/min) or adjusted/indexed to body surface area, relative GFR (mL/min/1.73 m2). Absolute and relative GFR have been used interchangeably to evaluate the risk of CI-AKI, which may be confusing and a potential source of errors. Relative GFR should be used to assess the GFR category of renal function as a sign of the degree of kidney damage and sensitivity for CI-AKI. Absolute GFR represents the excretion capacity of the individual and may be used to calculate the gram-iodine/absolute GFR ratio, an index of systemic drug exposure (amount of contrast medium in the body) that relates to toxicity. It has been found to be an independent predictor of AKI following percutaneous coronary angiography and interventions but has not yet been fully validated for computed tomography (CT). Prospective studies are warranted to evaluate the optimal gram-iodine/absolute GFR ratio to predict AKI at various stages of renal function at CT. Only GFR estimation (eGFR) equations based on standardized creatinine and/or cystatin C assays should be used. eGFRcystatin C/eGFRcreatinine ratio < 0.6 indicating selective glomerular hypofiltration syndrome may have a stronger predictive power for postcontrast AKI than creatinine‐based eGFR. Clinical relevance statement Once the degree of kidney damage is established by estimating relative GFR (mL/min/1.73 m2), contrast dose in relation to renal excretion capacity [gram-iodine/absolute GFR (mL/min)] may be the best index to evaluate the risk of contrast-induced kidney injury. Key Points • Relative glomerular filtration rate (GFR; mL/min/1.73 m2) should be used to assess the GFR category as a sign of the degree of kidney damage and sensitivity to contrast medium-induced acute kidney injury (CI-AKI). • Absolute GFR (mL/min) is the individual’s actual excretion capacity and the contrast-dose/absolute GFR ratio is a measure of systemic exposure (amount of contrast medium in the body), relates to toxicity and should be expressed in gram-iodine/absolute GFR (mL/min). • Prospective studies are warranted to evaluate the optimal contrast medium dose/GFR ratio predicting the risk of CI-AKI at CT and intra-arterial examinations.

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“…The area under the curve is a fundamental parameter used to express systemic exposure of drugs excreted by means of glomerular filtration that often correlates well with the drug's efficacy and toxicity and is, as such, a critical link between dosing and clinical end points (11,13). Therefore, absolute GFR should be used for evaluation of toxicity of drugs excreted by means of glomerular filtration (14).…”

Section: Risk Stratification According To Absolute Instead Of Relativmentioning

confidence: 99%

“…Another issue is the uncertainty of GFR estimations in general. Approximately 20%-30% of GFR estimations have an error exceeding 30% in relation to measured GFR, mainly large overestimations (15), which may lead to additional misclassification of GFR stages (14).…”

Section: Risk Stratification According To Absolute Instead Of Relativmentioning

confidence: 99%

Controversies in Contrast Material−induced Acute Kidney Injury: Propensity Score Matching of Patients with Different Dose/Absolute Glomerular Filtration Rate Ratios

Nyman¹,

Aspelin²,

Jakobsen³

et al. 2015

Radiology

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Estimating GFR prior to contrast medium examinations—what the radiologist needs to know!

Abstract: • Traceability of creatinine/cystatin C assays used in GFR equations must be defined. • Absolute, not relative, GFR should be used when dosing contrast media. • Consult the local laboratory or nephrologist to choose the proper GFR equation.

Cited by 7 publications

References 84 publications

The Complexities of Interpreting Reversible Elevated Serum Creatinine Levels in Drug Development: Does a Correlation with Inhibition of Renal Transporters Exist?

The Complexities of Interpreting Reversible Elevated Serum Creatinine Levels in Drug Development: Does a Correlation with Inhibition of Renal Transporters Exist?

Absolute and relative GFR and contrast medium dose/GFR ratio: cornerstones when predicting the risk of acute kidney injury

Controversies in Contrast Material−induced Acute Kidney Injury: Propensity Score Matching of Patients with Different Dose/Absolute Glomerular Filtration Rate Ratios

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