Safety of Iohexol Administration to Measure Glomerular Filtration Rate in Different Patient Populations: A 25-Year Experience

Abstract

Background/Aim: In clinical research setting, accurate and precise measurement of glomerular filtration rate (GFR) is essential to overcome the limitations of GFR estimation with equations, which are often unreliable. In recent decades, a method for measuring GFR by plasma clearance of iohexol, a non-ionic radiocontrast agent, was developed. To evaluate the safety of the procedure, we aimed to review all immediate adverse reactions that could be related to iohexol administration in our group’s 25 years worth of experience. Methods: We retrospectively reviewed all GFR investigations in 2,891 patients, between 1992 and 2016, as part of 37 clinical trials coordinated by our group. Subjects with disparate renal diseases, kidney transplant recipients, and living donors – all with different renal function categories – were included in the surveyed clinical trials. Results: During 15,147 GFR measurements, only one treatment-related event of moderate intensity was identified. Flushing, urticaria, and itching were observed in a diabetic patient a few minutes after iohexol administration during the first GFR measurement. The event recovered without sequelae after intravenous injection of methylprednisolone sodium succinate. The patient was not hospitalized and the event was categorized as non-serious. Eight additional non-serious events observed closely following iohexol injection were considered as not related to treatment. Thus, independent of disease conditions and GFR categories, the overall rate of treatment-related events was 0.0066%. Conclusion: Iohexol administration for GFR measurement is a safe procedure, even in repeated investigations in the same subject, that should be adopted in clinical research and, when needed, also in clinical practice.

Impact of errors of creatinine and cystatin C equations in the selection of living kidney donors

“…In addition, iohexol plasma clearance is not expensive, costing €100–200 [32, 33], which is negligible compared with the cost of renal transplantation. The procedure is safe, as shown in a recent publication with 2891 patients (15 147 GFR measurements), with only one treatment-related event (0.0066%) of moderate intensity [34]. Finally, as with other procedures in clinical medicine such as angiography, colonoscopy and magnetic resonance, the procedure is time-consuming; however, the benefits of accurate and precise determination of renal function in this population clearly outweigh this particular limitation.…”

Application of Herbal Medicines with Heat-Clearing Property to Anti-Microinflammation in the Treatment of Diabetic Kidney Disease

“…A growing number of reviews present a common consensus that adhesion molecules (e.g., intercellular cell adhesion molecule (ICAM)-1), diverse inflammatory cytokines (e.g., interleukin (IL)-1, IL-6, IL-18, and tumor necrosis factor-alpha (TNF- α )), and chemokines (e.g., monocyte chemotactic protein-1 (MCP-1)/chemokine C-C motif ligand 2 (CCL2), C-X3-C motif chemokine (CX3CL1), and CCL5/RANTES) are involved in the pathogenesis of DKD. Activation of the JAK/STAT pathway is also crucial, as it results in activation of NF-kB, a key transcription factor for inflammatory processes in DKD [18, 20, 23, 24]. Recently, there are increasing amounts of research focusing on the NOD-like receptor protein 3 (NLRP3) inflammasome in the onset and development of DKD.…”

Conventional Pig as Animal Model for Human Renal Drug Excretion Processes: Unravelling the Porcine Renal Function by Use of a Cocktail of Exogenous Markers

“…Therefore, the GFR is often estimated in daily practice using formulas derived from the serum creatinine concentrations. Iohexol, which is a nonradioactive GFR marker, is increasingly used in both veterinary and human medicine because its properties approach those of an ideal GFR marker (Miyamoto, 2001;Meucci et al, 2015;Zhang et al, 2017;Gaspari et al, 2018). More specifically, iohexol has only negligible binding to plasma proteins and is metabolically inert.…”