GFR measurement with iohexol and 51Cr-EDTA. A comparison of the two favoured GFR markers in Europe

Brändström, E; A, Grzegorczyk; Jacobsson, Lars; Friberg, Peter; Lindahl, Anders; Aurell, Mattias

doi:10.1093/ndt/13.5.1176

Cited by 150 publications

(93 citation statements)

References 9 publications

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“…Advantages of iohexol include feasibility, especially in older adults, stability in biological fluids, lack of radioactivity, and rare adverse reactions when given in small doses (when assayed with a sensitive HPLC assay) (26)(27)(28)(29). Studies have confirmed the agreement of GFR measurements obtained by this method with those obtained by inulin (26,30) and Cr-ethylenediaminetetraacetic acid clearance (29,31). External quality control was provided by Equalis (Uppsala, Sweden).…”

Section: Iohexol Samplesmentioning

confidence: 55%

Two Novel Equations to Estimate Kidney Function in Persons Aged 70 Years or Older

Schaeffner¹,

Ebert²,

Delanaye³

et al. 2012

Ann Intern Med

526

452

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Background: In older adults, current equations to estimate glomerular filtration rate (GFR) are not validated and may misclassify elderly persons in terms of their stage of chronic kidney disease. Objective: To derive the Berlin Initiative Study (BIS) equation, a novel estimator of GFR in elderly participants. Design: Cross-sectional. Data were split for analysis into 2 sets for equation development and internal validation. Setting: Random community-based population of a large insurance company. Participants: 610 participants aged 70 years or older (mean age, 78.5 years). Intervention: lohexol plasma clearance measurement as gold standard. Measurements: GFR, measured as the plasma clearance of the endogenous marker iohexol, to compare performance of existing equations of estimated GFR with measured GFR of the gold standard; estimation of measured GFR from standardized creatinine and cystatin C levels, sex, and age in the learning sample; and comparison of the BIS equations (BIS1: creatinine-based; BIS2: creatinine-and cystatin C-based) with other estimating equations and determination of bias, precision, and accuracy in the validation sample. Results:The new BIS2 equation yielded the smallest bias followed by the creatinine-based BIS1 and CockcroftGault equations. All other equations considerably overestimated GFR. The BIS equations confirmed a high prevalence of persons older than 70 years with a GFR less than 60 mL/min per 1.73 m 2 (BIS1, 50.4%; BIS2, 47.4%; measured GFR, 47.9%). The total misclassification rate for this criterion was smallest for the BIS2 equation (11.6%), followed by the cystatin C equation 2 (15.1%) proposed by the Chronic Kidney Disease Epidemiology Collaboration. Among the creatinine-based equations, BIS1 had the smallest misclassification rate (17.2%), followed by the Chronic Kidney Disease Epidemiology Collaboration equation (20.4%). Limitation: There was no validation by an external data set. Conclusion: The BIS2 equation should be used to estimate GFR in persons aged 70 years or older with normal or mild to moderately reduced kidney function. If cystatin C is not available, the BIS1 equation is an acceptable alternative. Primary Funding Source: Kuratorium für Dialyse und Nierentransplatation (KfH) Foundation of Preventive Medicine.

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Section: Iohexol Samplesmentioning

confidence: 55%

Two Novel Equations to Estimate Kidney Function in Persons Aged 70 Years or Older

Schaeffner¹,

Ebert²,

Delanaye³

et al. 2012

Ann Intern Med

526

452

View full text Add to dashboard Cite

show abstract

“…This method has been validated against gold standard methods for measuring GFR. [23][24][25][26][27][28][29] The subjects were instructed to avoid large meals with meat and nonsteroid anti-inflammatory drugs for 2 days before the investigation. The measurements were performed after fasting and abstinence from nicotine.…”

Section: Subjectsmentioning

confidence: 99%

“…The catheter was flushed with 30 ml of isotonic saline and used for iohexol analysis samples. 27 The optimal time for measuring iohexol concentration after injection was calculated by Jacobsson's method on the basis of the GFR estimated from creatinine. 30 To ensure complete distribution of iohexol in the extracellular fluid volume, the shortest sampling time was set at 180 minutes.…”

Section: Subjectsmentioning

confidence: 99%

GFR Normalized to Total Body Water Allows Comparisons across Genders and Body Sizes

Eriksen

Melsom

Mathisen

et al. 2011

Journal of the American Society of Nephrology

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The normalization of GFR to a standardized body-surface area of 1.73 m 2 impedes comparison of GFR across individuals of different genders, heights, or weights. Ideally, GFR should be normalized to a parameter that best explains variation in GFR. Here, we measured true GFR by iohexol clearance in a representative sample of 1627 individuals from the general population who did not have diabetes, cardiovascular disease, or kidney disease. We also estimated total body water (TBW), extracellular fluid volume, lean body mass, liver volume, metabolic rate, and body-surface area. We compared two methods of normalizing GFR to these physiologic variables: (1) the conventional method of scaling GFR to each physiologic variable by simple division and (2) a method based on regression of the GFR on each variable. TBW explained a higher proportion of the variation in GFR than the other physiologic variables. GFR adjusted for TBW by the regression method exhibited less dependence on gender, height, and weight compared with the other physiologic variables. Thus, adjusting GFR for TBW by the regression method allows direct comparisons between individuals of different genders, weights, and heights. We propose that regression-based normalization of GFR to a standardized TBW of 40 L should replace the current practice of normalizing GFR to 1.73 m 2 of body-surface area.

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“…The renal clearance of inulin is thus the "gold standard" for the GFR measurement. However, its application is expensive and tedious [2]. Moreover, inulin is not always easily available on the market.…”

Section: Introductionmentioning

confidence: 99%

“…Contrast agents like iothalamate or iohexol (N, N'-bis (2,3-dihydroxypropyl)-5-(N-2,3-dihydroxypropyl)acetamido)-2,4,6-triiodoisophtalamide) are also available and have the features of the ideal marker together with being easily available and safe. Thus iohexol clearance is replacing inulin clearance as a marker of choice for GFR [2,[8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Performance of iohexol determination in serum and urine by HPLC: Validation, risk and uncertainty assessment

Cavalier

Rozet

Dubois

et al. 2008

Clinica Chimica Acta

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Background: Determination of glomerular filtration rate plays an important role in nephrological practice. Iohexol is a reference marker for glomerular filtration rate determination. It is available and safe. The aim of this study was to develop a simple, efficient and easy to use analytical method for the quantification of iohexol in serum and urine by high performance liquid chromatography and to thoroughly validate this method. Methods: The HPLC method was inspired from the method published by Krutzen. The e.noval software V2.0 (Arlenda, Liège, Belgium) was used to compute all validation results. Results: The validation results indicate that the method will give accurate and reliable results for serum values ranging from 12.95 to 1295 μg/ml and for urine values ranging from 86.0 to 4144 μg/ml. In routine practice, iohexol concentrations found in plasma after injection range from 40 to 600 μg/ml. The expected urinary values are much wider. One should not hesitate to dilute urine samples to fit with the validated range over 5000 μg/ml. Conclusion: This is the first time that a reference method for the determination of GFR is validated with such a rigorous and thorough protocol. Contrary to other GFR markers, iohexol is now strongly validated from an analytical point of view.

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GFR measurement with iohexol and 51Cr-EDTA. A comparison of the two favoured GFR markers in Europe

Cited by 150 publications

References 9 publications

Two Novel Equations to Estimate Kidney Function in Persons Aged 70 Years or Older

Two Novel Equations to Estimate Kidney Function in Persons Aged 70 Years or Older

GFR Normalized to Total Body Water Allows Comparisons across Genders and Body Sizes

Performance of iohexol determination in serum and urine by HPLC: Validation, risk and uncertainty assessment

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