Ambulatory GFR measurement with cold iothalamate in adults with chronic kidney disease.

Abstract

BACKGROUND:

The purpose of this study is to develop a method that eliminates the use of radioactive agents, reduces the length of inpatient visits, and does not require urine collection for the measurement of glomerular filtration rate (GFR) in adults with chronic kidney diseases (CKD).

METHODS:

We measured simultaneous urinary and plasma clearance of iothalamate using high-performance liquid chromatography in 30 patients with CKD after a continuous subcutaneous infusion of iothalamate at a rate of 125 microL/h for a 24-hour period. To ascertain whether a steady state was achieved with a 24-hour infusion, in 20 additional patients, we infused iothalamate continuously for 48 hours and measured GFR after 24 and 48 hours.

RESULTS:

Plasma iothalamate levels and urinary excretion rates obtained after 24- and 48-hour infusions were similar. GFR estimated by plasma clearance (44.4 mL/min; 95% confidence interval [CI], 37.0 to 53.3) was similar to urinary clearance (41.6 mL/min; 95% CI, 34.7 to 50.0) and without bias (average difference, 7%; 95% CI, +18% to -38%; P = 0.866). There also was acceptable agreement between plasma and urinary clearance of iothalamate (coefficient of variation [CV], 19.6% between techniques). Reproducibility of day-to-day plasma continuous infusion clearance technique was less than 12%. There was good agreement (CV, 19.9%) between inulin and renal iothalamate clearances.

CONCLUSION:

These data show that ambulatory infusion of iothalamate can be used to measure GFR in adults with CKD without the need for urine collections with acceptable precision and without exposure to radioactivity.

• Authors: Rajiv Agarwal
• Journal: American journal of kidney diseases : the official journal of the National Kidney Foundation (Am J Kidney Dis) Vol. 41 Issue 4 Pg. 752-9 (Apr 2003) ISSN: 1523-6838 [Electronic] United States
• PMID: 12666061 (Publication Type: Evaluation Study, Journal Article, Validation Study)

Chemical References

• Iothalamic Acid
• Inulin

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Ambulatory Care
• Chromatography, High Pressure Liquid
• Chronic Disease
• Comorbidity
• Female
• Glomerular Filtration Rate
• Half-Life
• Humans
• Infusion Pumps, Implantable
• Infusions, Parenteral
• Inulin (analysis, pharmacokinetics)
• Iothalamic Acid (administration & dosage, analysis, pharmacokinetics)
• Kidney Diseases (physiopathology)
• Male
• Metabolic Clearance Rate
• Middle Aged
• Reproducibility of Results