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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?

Delanaye, Pierre; Ebert, Natalie; Melsom, Toralf; Gaspari, Flavio; Mariat, Christophe; Cavalier, Etienne; Björk, Jonas LU ; Christensson, Anders LU ; Nyman, Ulf LU and Porrini, Esteban, et al. (2016) In Clinical Kidney Journal 9(5). p.682-699
Abstract

While there is general agreement on the necessity tomeasure glomerular filtration rate (GFR) inmany clinical situations, there is less agreement on the bestmethod to achieve this purpose. As the gold standardmethod for GFR determination, urinary (or renal) clearance of inulin, fades into the background due to inconvenience and high cost, a diversity of filtrationmarkers and protocols compete to replace it. In this review, we suggest that iohexol, a non-ionic contrast agent, is most suited to replace inulin as the marker of choice for GFR determination. Iohexol comes very close to fulfilling all requirements for an ideal GFRmarker in terms of low extra-renal excretion, low protein binding and in being neither secreted nor reabsorbed by... (More)

While there is general agreement on the necessity tomeasure glomerular filtration rate (GFR) inmany clinical situations, there is less agreement on the bestmethod to achieve this purpose. As the gold standardmethod for GFR determination, urinary (or renal) clearance of inulin, fades into the background due to inconvenience and high cost, a diversity of filtrationmarkers and protocols compete to replace it. In this review, we suggest that iohexol, a non-ionic contrast agent, is most suited to replace inulin as the marker of choice for GFR determination. Iohexol comes very close to fulfilling all requirements for an ideal GFRmarker in terms of low extra-renal excretion, low protein binding and in being neither secreted nor reabsorbed by the kidney. In addition, iohexol is virtually non-Toxic and carries a low cost. As iohexol is stable in plasma, administration and sample analysis can be separated in both space and time, allowing access to GFR determination across different settings. An external proficiency programme operated by Equalis AB, Sweden, exists for iohexol, facilitating interlaboratory comparison of results. Plasma clearance measurement is the protocol of choice as it combines a reliable GFR determination with convenience for the patient. Single-sample protocols dominate, butmultiple-sample protocolsmay bemore accurate in specific situations. In lowGFRs one ormore late samples should be included to improve accuracy. In patients with large oedema or ascites, urinary clearance protocols should be employed. In conclusion, plasma clearance of iohexol may well be the best candidate for a common GFR determination method.

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publication status
published
subject
keywords
Glomerular filtration rate, Iohexol
in
Clinical Kidney Journal
volume
9
issue
5
pages
18 pages
publisher
Oxford University Press
external identifiers
  • scopus:84995569547
  • wos:000386131400007
ISSN
2048-8505
DOI
10.1093/ckj/sfw070
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English
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yes
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3322e257-0db0-4edf-9082-432748b85cb3
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2016-12-05 08:31:27
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2017-09-18 11:29:51
@article{3322e257-0db0-4edf-9082-432748b85cb3,
  abstract     = {<p>While there is general agreement on the necessity tomeasure glomerular filtration rate (GFR) inmany clinical situations, there is less agreement on the bestmethod to achieve this purpose. As the gold standardmethod for GFR determination, urinary (or renal) clearance of inulin, fades into the background due to inconvenience and high cost, a diversity of filtrationmarkers and protocols compete to replace it. In this review, we suggest that iohexol, a non-ionic contrast agent, is most suited to replace inulin as the marker of choice for GFR determination. Iohexol comes very close to fulfilling all requirements for an ideal GFRmarker in terms of low extra-renal excretion, low protein binding and in being neither secreted nor reabsorbed by the kidney. In addition, iohexol is virtually non-Toxic and carries a low cost. As iohexol is stable in plasma, administration and sample analysis can be separated in both space and time, allowing access to GFR determination across different settings. An external proficiency programme operated by Equalis AB, Sweden, exists for iohexol, facilitating interlaboratory comparison of results. Plasma clearance measurement is the protocol of choice as it combines a reliable GFR determination with convenience for the patient. Single-sample protocols dominate, butmultiple-sample protocolsmay bemore accurate in specific situations. In lowGFRs one ormore late samples should be included to improve accuracy. In patients with large oedema or ascites, urinary clearance protocols should be employed. In conclusion, plasma clearance of iohexol may well be the best candidate for a common GFR determination method.</p>},
  author       = {Delanaye, Pierre and Ebert, Natalie and Melsom, Toralf and Gaspari, Flavio and Mariat, Christophe and Cavalier, Etienne and Björk, Jonas and Christensson, Anders and Nyman, Ulf and Porrini, Esteban and Remuzzi, Giuseppe and Ruggenenti, Piero and Schaeffner, Elke and Soveri, Inga and Sterner, Gunnar and Eriksen, Bjørn Odvar and Bäck, Sten Erik},
  issn         = {2048-8505},
  keyword      = {Glomerular filtration rate,Iohexol},
  language     = {eng},
  number       = {5},
  pages        = {682--699},
  publisher    = {Oxford University Press},
  series       = {Clinical Kidney Journal},
  title        = {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?},
  url          = {http://dx.doi.org/10.1093/ckj/sfw070},
  volume       = {9},
  year         = {2016},
}