Advanced

Measuring GFR: A Systematic Review.

Soveri, Inga; Berg, Ulla B; Björk, Jonas LU ; Elinder, Carl-Gustaf; Grubb, Anders LU ; Mejare, Ingegerd; Sterner, Gunnar LU and Bäck, Sten-Erik LU (2014) In American Journal of Kidney Diseases 64(3). p.411-424
Abstract
Background No comprehensive systematic review of the accuracy of glomerular filtration rate (GFR) measurement methods using renal inulin clearance as reference has been published. Study Design Systematic review with meta-analysis of cross-sectional diagnostic studies. Setting & Population Published original studies and systematic reviews in any population. Selection Criteria for Studies

Index and reference measurements conducted within 48 hours; at least 15 participants studied; GFR markers measured in plasma or urine; plasma clearance calculation algorithm verified in another study; tubular secretion of creatinine had not been blocked by medicines.

Index Tests Endogenous creatinine clearance; renal or plasma... (More)
Background No comprehensive systematic review of the accuracy of glomerular filtration rate (GFR) measurement methods using renal inulin clearance as reference has been published. Study Design Systematic review with meta-analysis of cross-sectional diagnostic studies. Setting & Population Published original studies and systematic reviews in any population. Selection Criteria for Studies

Index and reference measurements conducted within 48 hours; at least 15 participants studied; GFR markers measured in plasma or urine; plasma clearance calculation algorithm verified in another study; tubular secretion of creatinine had not been blocked by medicines.

Index Tests Endogenous creatinine clearance; renal or plasma clearance of chromium 51−labeled ethylenediaminetetraacetic acid (51Cr-EDTA), diethylenetriaminepentaacetic acid (DTPA), iohexol, and iothalamate; and plasma clearance of inulin. Reference Test Renal inulin clearance measured under continuous inulin infusion and urine collection. Results Mean bias < 10%, median bias < 5%, the proportion of errors in the index measurements that did not exceed 30% (P30) ≥ 80%, and P10 ≥ 50% were set as requirements for sufficient accuracy. Based on the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach, the quality of evidence across studies was rated for each index method. Renal clearance of iothalamate measured GFR with sufficient accuracy (strong evidence). Renal and plasma clearance of 51Cr-EDTA and plasma clearance of iohexol were sufficiently accurate to measure GFR (moderately strong evidence). Renal clearance of DTPA, renal clearance of iohexol, and plasma clearance of inulin had sufficient accuracy (limited evidence). Endogenous creatinine clearance was an inaccurate method (strong evidence), as was plasma clearance of DTPA (limited evidence). The evidence to determine the accuracy of plasma iothalamate clearance was insufficient. With the exception of plasma clearance of inulin, only renal clearance methods had P30 > 90%.

Limitations The included studies were few and most were old and small, which may limit generalizability. Requirements for sufficient accuracy may depend on clinical setting. At least moderately strong evidence suggests that renal clearance of 51Cr-EDTA or iothalamate and plasma clearance of 51Cr-EDTA or iohexol are sufficiently accurate methods to measure GFR. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
American Journal of Kidney Diseases
volume
64
issue
3
pages
411 - 424
publisher
Elsevier
external identifiers
  • pmid:24840668
  • wos:000341357100018
  • scopus:84908121455
ISSN
1523-6838
DOI
10.1053/j.ajkd.2014.04.010
language
English
LU publication?
yes
id
8614f2af-7e62-41c9-8fe0-c71d9fbe2a3c (old id 4454151)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/24840668?dopt=Abstract
date added to LUP
2014-06-04 21:53:54
date last changed
2017-11-19 03:22:39
@article{8614f2af-7e62-41c9-8fe0-c71d9fbe2a3c,
  abstract     = {Background No comprehensive systematic review of the accuracy of glomerular filtration rate (GFR) measurement methods using renal inulin clearance as reference has been published. Study Design Systematic review with meta-analysis of cross-sectional diagnostic studies. Setting &amp; Population Published original studies and systematic reviews in any population. Selection Criteria for Studies<br/><br>
Index and reference measurements conducted within 48 hours; at least 15 participants studied; GFR markers measured in plasma or urine; plasma clearance calculation algorithm verified in another study; tubular secretion of creatinine had not been blocked by medicines.<br/><br>
Index Tests Endogenous creatinine clearance; renal or plasma clearance of chromium 51−labeled ethylenediaminetetraacetic acid (51Cr-EDTA), diethylenetriaminepentaacetic acid (DTPA), iohexol, and iothalamate; and plasma clearance of inulin. Reference Test Renal inulin clearance measured under continuous inulin infusion and urine collection. Results Mean bias &lt; 10%, median bias &lt; 5%, the proportion of errors in the index measurements that did not exceed 30% (P30) ≥ 80%, and P10 ≥ 50% were set as requirements for sufficient accuracy. Based on the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach, the quality of evidence across studies was rated for each index method. Renal clearance of iothalamate measured GFR with sufficient accuracy (strong evidence). Renal and plasma clearance of 51Cr-EDTA and plasma clearance of iohexol were sufficiently accurate to measure GFR (moderately strong evidence). Renal clearance of DTPA, renal clearance of iohexol, and plasma clearance of inulin had sufficient accuracy (limited evidence). Endogenous creatinine clearance was an inaccurate method (strong evidence), as was plasma clearance of DTPA (limited evidence). The evidence to determine the accuracy of plasma iothalamate clearance was insufficient. With the exception of plasma clearance of inulin, only renal clearance methods had P30 &gt; 90%.<br/><br>
Limitations The included studies were few and most were old and small, which may limit generalizability. Requirements for sufficient accuracy may depend on clinical setting. At least moderately strong evidence suggests that renal clearance of 51Cr-EDTA or iothalamate and plasma clearance of 51Cr-EDTA or iohexol are sufficiently accurate methods to measure GFR.},
  author       = {Soveri, Inga and Berg, Ulla B and Björk, Jonas and Elinder, Carl-Gustaf and Grubb, Anders and Mejare, Ingegerd and Sterner, Gunnar and Bäck, Sten-Erik},
  issn         = {1523-6838},
  language     = {eng},
  number       = {3},
  pages        = {411--424},
  publisher    = {Elsevier},
  series       = {American Journal of Kidney Diseases},
  title        = {Measuring GFR: A Systematic Review.},
  url          = {http://dx.doi.org/10.1053/j.ajkd.2014.04.010},
  volume       = {64},
  year         = {2014},
}