[en] Background: There are many different ways to measure glomerular filtration rate (GFR) using various exogenous filtration markers, each having their own strengths and limitations. However, not only the marker, but also the methodology may vary in many ways, including the use of urinary or plasma clearance, and, in the case of plasma clearance, the number of time points used to calculate the area under the concentration-time curve, ranging from only one (Jacobsson method) to eight (or more) blood samples. Methods: We collected the results obtained from 5106 plasma clearances (iohexol or 51Cr-ethylenediaminetetraacetic acid (EDTA)) using three to four time points, allowing GFR calculation using the slope-intercept method and the Brochner-Mortensen correction. For each time point, the Jacobsson formula was applied to obtain the single-sample GFR. We used Bland-Altman plots to determine the accuracy of the Jacobsson method at each time point. Results: The single-sample method showed within 10% concordances with the multiple-sample method of 66.4%, 83.6%, 91.4% and 96.0% at the time points 120, 180, 240 and >/=300 min, respectively. Concordance was poorer at lower GFR levels, and this trend is in parallel with increasing age. Results were similar in males and females. Some discordance was found in the obese subjects. Conclusion: Single-sample GFR is highly concordant with a multiple-sample strategy, except in the low GFR range (<30 mL/min).
Disciplines :
Laboratory medicine & medical technology Urology & nephrology
Author, co-author :
DELANAYE, Pierre ; Centre Hospitalier Universitaire de Liège - CHU > Service de néphrologie
Flamant, Martin
Dubourg, Laurence
Vidal-Petiot, Emmanuelle
Lemoine, Sandrine
Cavalier, Etienne ; Université de Liège - ULiège > Département de pharmacie > Chimie médicale
Schaeffner, Elke
Ebert, Natalie
Pottel, Hans
Language :
English
Title :
Single- versus multiple-sample method to measure glomerular filtration rate.
Smith HW. Comparative physiology of the kidney. In: HWSmith (ed). The Kidney: Stucture and Function in Health and Disease. New York, NY: Oxford University Press, 1951, 520-574
Delanaye P, Melsom T, Ebert N et al. Iohexol plasma clearance for measuring glomerular filtration rate in clinical practice and research: a review. Part 2: Why to measure glomerular filtration rate with iohexol? Clin Kidney J 2016; 9: 700-704
Stevens LA, Levey AS. Measured GFR as a confirmatory test for estimated GFR. J Am Soc Nephrol 2009; 20: 2305-2313
Schei J, Stefansson VTN,Mathisen UD. Residual associations of inflammatory markers with eGFR after accounting for measured GFR in a communitybased cohort without CKD. Clin J Am Soc Nephrol 2016; 11: 280-286
Delanaye P, Mariat C. The applicability of eGFR equations to different populations. Nat Rev Nephrol 2013; 9: 513-522
Delanaye P. How measuring glomerular filtration rate? Comparison of reference methods. In: Manisha S (ed). Basic Nephrology and Acute Kidney Injury. InTech, 2012, 1-40. DOI: 10.5772/25770
Soveri I, Berg UB, Björk J et al. Measuring GFR: a systematic review. Am J Kidney Dis 2014; 64: 411-424
Delanaye P, Melsom T, Ebert N et al. Iohexol plasma clearance for measuring glomerular filtration rate in clinical practice and research: a review. Part 1: How to measure glomerular filtration rate with iohexol? Clin Kidney J 2016; 9: 700-704
Stolz A, Hoizey G, Toupance O et al. Evaluation of sample bias for measuring plasma iohexol clearance in kidney transplantation. Transplantation 2010; 89: 440-445
Skluzacek PA, Szewc RG, Nolan CR III et al. Prediction of GFR in liver transplant candidates. Am J Kidney Dis 2003; 42: 1169-1176
Ebert N, Loesment A, Martus P et al. Iohexol plasma clearance measurement in older adults with chronic kidney disease-sampling time matters. Nephrol Dial Transplant 2015; 30: 1307-1314
Gaspari F, Perico N, Ruggenenti P et al. Plasma clearance of nonradioactive iohexol as a measure of glomerular filtration rate. J Am SocNephrol 1995; 6: 257-263
Berg UB, Back R, Celsi G et al. Comparison of plasma clearance of iohexol and urinary clearance of inulin for measurement of GFR in children. Am J Kidney Dis 2011; 57: 55-61
Agarwal R, Bills JE, Yigazu PM et al. Assessment of iothalamate plasma clearance: duration of study affects quality of GFR. Clin J Am Soc Nephrol 2009; 4: 77-85
Gaspari F, Guerini E, Perico N et al. Glomerular filtration rate determined from a single plasma sample after intravenous iohexol injection: is it reliable? J AmSoc Nephrol 1996; 7: 2689-2693
Sterner G, Frennby B, Hultberg B et al. Iohexol clearance for GFRdetermination in renal failure-single or multiple plasma sampling? Nephrol Dial Transplant 1996; 11: 521-525
Bird NJ, Peters C, Michell AR et al. Comparison of GFR measurements assessed from single versus multiple samples. Am J Kidney Dis 2009; 54: 278-288
Brändström E, Grzegorczyk A, Jacobsson L et al. GFR measurement with iohexol and 51Cr-EDTA. A comparison of the two favoured GFR markers in Europe.Nephrol Dial Transplant 1998; 13: 1176-1182
Lundqvist S, Hietala SO, Groth S et al. Evaluation of single sample clearance calculations in 902 patients. A comparison of multiple and single sample techniques. Acta Radiol 1997; 38: 68-72
Bröchner-Mortensen J. A simple method for the determination of glomerular filtration rate. Scand J Clin Lab Invest 1972; 30: 271-274
Jacobsson L. A method for the calculation of renal clearance based on a single plasma sample. Clin Physiol 1983; 3: 297-305
Delanaye P, Jouret F, Le Goff C et al. Concordance between iothalamate and iohexol plasma clearance. Am J Kidney Dis 2016; 68: 329-330
Vidal-Petiot E, Haymann J-P, Letavernier E et al. External validation of the BIS (Berlin Initiative Study)-1 GFR estimating equation in the elderly. Am J Kidney Dis 2014; 63: 865-867
Lemoine S, Guebre-Egziabher F, Sens F et al. Accuracy of GFR estimation in obese patients. Clin J AmSoc Nephrol 2014; 9: 720-727
Schaeffner ES, Ebert N, Delanaye P et al. Two novel equations to estimate kidney function in persons aged 70 years or older. Ann Intern Med 2012; 157: 471-481
Delanaye P, Krzesinski J-MM. Indexing of renal function parameters by body surface area: intelligence or folly? Nephron Clin Pract 2011; 119: c289-c292
Pottel H, Hoste L, De Waele L et al. Measuring glomerular filtration rate using 51Cr-EDTA: body surface area normalization before or after Bröchner-Mortensen correction? Nucl Med Commun 2014; 35: 1150-1155
Piéroni L, Delanaye P, Boutten A et al. A multicentric evaluation of IDMStraceable creatinine enzymatic assays. Clin Chim Acta 2011; 412: 2070-2075
Pottel H, Hoste L, Dubourg L et al. A new estimating glomerular filtration rate equation for the full age spectrum. Nephrol Dial Transplant 2016; 31: 798-806
Lin LI. A concordance correlation coefficient to evaluate reproducibility. Biometrics 1989; 45: 255-268
Pottel H, Delanaye P, Schaeffner ES et al. Estimating glomerular filtration rate for the full age spectrum from serum creatinine and cystatin C. Nephrol Dial Transplant 2017; 32: 497-507
Bjork J, Grubb A, Larsson A et al. Accuracy of GFR estimating equations combining standardized cystatin C and creatinine assays: a cross-sectional study in Sweden. Clin Chem LabMed 2015; 53: 403-414
Inker LA, Schmid CH, Tighiouart H et al. Estimating glomerular filtration rate from serum creatinine and cystatin C.N Engl JMed 2012; 367: 20-29
Pottel H, Hoste L, Yayo E et al. Glomerular filtration rate in healthy living potential kidney donors: a meta-analysis. Nephron 2017; 135: 105-119
Gaspari F, Mosconi L, Viganò G et al. Measurement of GFR with a single intravenous injection of nonradioactive iothalamate. Kidney Int 1992; 41: 1081-1084
Rydström M, Tengström B, Cederquist I et al. Measurement of glomerular filtration rate by single-injection, single-sample techniques, using 51Cr-EDTA or iohexol. Scand J Urol Nephrol 1995; 29: 135-139
Stake G, Monn E, Rootwelt K et al. A single plasma sample method for estimation of the glomerular filtration rate in infants and children using iohexol, II: Establishment of the optimal plasma sampling time and a comparison with the 99Tcm-DTPA method. Scand J Clin Lab Invest 1991; 51: 343-348
Gaspari F, Ruggenenti P, Porrini E et al. The GFR and GFR decline cannot be accurately estimated in type 2 diabetics. Kidney Int 2013; 84: 164-173
Thomsen HS, Hvid-Jacobsen K. Estimation of glomerular filtration rate from low-dose injection of iohexol and a single blood sample. Invest Radiol 1991; 26: 332-336
Stake G, Monn E, Rootwelt K et al. The clearance of iohexol as a measure of the glomerular filtration rate in children with chronic renal failure. Scand J Clin Lab Invest 1991; 51: 729-734
Frennby B, Sterner G, Almen T et al. Determination of low glomerular filtration rate using iohexol clearance. Invest Radiol 1994; 29: S234-S235
Frennby B, Sterner G, Almen T et al. The use of iohexol clearance to determine GFR in patients with severe chronic renal failure-a comparison between different clearance techniques. Clin Nephrol 1995; 43: 35-46
Nossen J. Ø, Jakobsen JA? , Kjærsgaard P et al. Elimination of the non-ionic X-ray contrast media iodixanol and iohexol in patients with severely impaired renal function. Scand J Clin Lab Invest 1995; 55: 341-350
Chowdhury TA, Dyer PH, Bartlett WA et al. Glomerular filtration rate determination in diabetic patients using iohexol clearance-comparison of single and multiple plasma sampling methods. Clin Chim Acta 1998; 277: 153-158
James TJ, Lewis AV, Tan GD et al. Validity of simplified protocols to estimate glomerular filtration rate using iohexol clearance. Ann Clin Biochem 2007; 44: 369-376
Sterner G, Frennby B, Mansson S et al. Determining 'true' glomerular filtration rate in healthy adults using infusion of inulin and comparing it with values obtained using other clearance techniques or prediction equations. Scand J Urol Nephrol 2008; 42: 278-285
Stake G, Monclair T. A single plasma sample method for estimation of the glomerular filtration rate in infants and children using iohexol, I: establishment of a body weight-related formula for the distribution volume of iohexol. Scand J Clin Lab Invest 1991; 51: 335-342
Chantler C, Garnett ES, Parsons V et al. Glomerular filtration rate measurement in man by the single injection methods using 51Cr-EDTA. Clin Sci 1969; 37: 169-180
Rehling M, Rabol A. Measurement of glomerular filtration rate in adults: accuracy of five single-sample plasma clearance methods. Clin Physiol 1989; 9: 171-182
Tauxe WN. Determination of glomerular filtration rate by single-plasma sampling technique following injection of radioiodinated diatrizoate. J Nucl Med 1986; 27: 45-50
Groth S, Aasted M. 51Cr-EDTA clearance determined by one plasma sample. Clin Physiol 1981; 1: 417-425
Russell CD, Bischoff PG, Kontzen FN et al. Measurement of glomerular filtration rate: single injection plasma clearance method without urine collection. J NuclMed 1985; 26: 1243-1247
Christensen AB, Groth S. Determination of 99mTc-DTPA clearance by a single plasma samplemethod. Clin Physiol 1986; 6: 579-588
Brown SC, O'Reilly PH. Iohexol clearance for the determination of glomerular filtration rate in clinical practice: evidence for a new gold standard. J Urol 1991; 146: 675-679
Shafi T, Levey AS, Inker LA et al. Plasma iohexol clearance for assessing residual kidney function in dialysis patients. Am J Kidney Dis 2015; 66: 728-730
Eriksen BO,Mathisen UD, Melsom T et al. Cystatin C is not a better estimator of GFR than plasma creatinine in the general population. Kidney Int 2010; 78: 1305-1311
