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Absolute and relative GFR and contrast medium dose/GFR ratio : cornerstones when predicting the risk of acute kidney injury

Nyman, Ulf LU ; Leander, Peter LU ; Liss, Per ; Sterner, Gunnar LU and Brismar, Torkel (2023) In European Radiology
Abstract

Abstract: Glomerular filtration rate (GFR) is considered the best overall index of kidney function in health and disease and its use is recommended to evaluate the risk of iodine contrast medium-induced acute kidney injury (CI-AKI) either as a single parameter or as a ratio between the total contrast medium dose (gram iodine) and GFR. GFR may be expressed in absolute terms (mL/min) or adjusted/indexed to body surface area, relative GFR (mL/min/1.73 m2). Absolute and relative GFR have been used interchangeably to evaluate the risk of CI-AKI, which may be confusing and a potential source of errors. Relative GFR should be used to assess the GFR category of renal function as a sign of the degree of kidney damage and sensitivity... (More)

Abstract: Glomerular filtration rate (GFR) is considered the best overall index of kidney function in health and disease and its use is recommended to evaluate the risk of iodine contrast medium-induced acute kidney injury (CI-AKI) either as a single parameter or as a ratio between the total contrast medium dose (gram iodine) and GFR. GFR may be expressed in absolute terms (mL/min) or adjusted/indexed to body surface area, relative GFR (mL/min/1.73 m2). Absolute and relative GFR have been used interchangeably to evaluate the risk of CI-AKI, which may be confusing and a potential source of errors. Relative GFR should be used to assess the GFR category of renal function as a sign of the degree of kidney damage and sensitivity for CI-AKI. Absolute GFR represents the excretion capacity of the individual and may be used to calculate the gram-iodine/absolute GFR ratio, an index of systemic drug exposure (amount of contrast medium in the body) that relates to toxicity. It has been found to be an independent predictor of AKI following percutaneous coronary angiography and interventions but has not yet been fully validated for computed tomography (CT). Prospective studies are warranted to evaluate the optimal gram-iodine/absolute GFR ratio to predict AKI at various stages of renal function at CT. Only GFR estimation (eGFR) equations based on standardized creatinine and/or cystatin C assays should be used. eGFRcystatin C/eGFRcreatinine ratio < 0.6 indicating selective glomerular hypofiltration syndrome may have a stronger predictive power for postcontrast AKI than creatinine‐based eGFR. Clinical relevance statement: Once the degree of kidney damage is established by estimating relative GFR (mL/min/1.73 m2), contrast dose in relation to renal excretion capacity [gram-iodine/absolute GFR (mL/min)] may be the best index to evaluate the risk of contrast-induced kidney injury. Key Points: • Relative glomerular filtration rate (GFR; mL/min/1.73 m 2) should be used to assess the GFR category as a sign of the degree of kidney damage and sensitivity to contrast medium-induced acute kidney injury (CI-AKI). • Absolute GFR (mL/min) is the individual’s actual excretion capacity and the contrast-dose/absolute GFR ratio is a measure of systemic exposure (amount of contrast medium in the body), relates to toxicity and should be expressed in gram-iodine/absolute GFR (mL/min). • Prospective studies are warranted to evaluate the optimal contrast medium dose/GFR ratio predicting the risk of CI-AKI at CT and intra-arterial examinations.

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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
epub
subject
keywords
Acute kidney injury, Angiography, Computed tomography, Contrast media, Glomerular filtration rate
in
European Radiology
publisher
Springer
external identifiers
  • pmid:37540321
  • scopus:85166963908
ISSN
0938-7994
DOI
10.1007/s00330-023-09962-w
language
English
LU publication?
yes
id
8f060128-a79c-478f-99b8-a61d3b830fb6
date added to LUP
2023-11-21 13:40:15
date last changed
2024-04-18 16:52:52
@article{8f060128-a79c-478f-99b8-a61d3b830fb6,
  abstract     = {{<p>Abstract: Glomerular filtration rate (GFR) is considered the best overall index of kidney function in health and disease and its use is recommended to evaluate the risk of iodine contrast medium-induced acute kidney injury (CI-AKI) either as a single parameter or as a ratio between the total contrast medium dose (gram iodine) and GFR. GFR may be expressed in absolute terms (mL/min) or adjusted/indexed to body surface area, relative GFR (mL/min/1.73 m<sup>2</sup>). Absolute and relative GFR have been used interchangeably to evaluate the risk of CI-AKI, which may be confusing and a potential source of errors. Relative GFR should be used to assess the GFR category of renal function as a sign of the degree of kidney damage and sensitivity for CI-AKI. Absolute GFR represents the excretion capacity of the individual and may be used to calculate the gram-iodine/absolute GFR ratio, an index of systemic drug exposure (amount of contrast medium in the body) that relates to toxicity. It has been found to be an independent predictor of AKI following percutaneous coronary angiography and interventions but has not yet been fully validated for computed tomography (CT). Prospective studies are warranted to evaluate the optimal gram-iodine/absolute GFR ratio to predict AKI at various stages of renal function at CT. Only GFR estimation (eGFR) equations based on standardized creatinine and/or cystatin C assays should be used. eGFR<sub>cystatin C</sub>/eGFR<sub>creatinine</sub> ratio &lt; 0.6 indicating selective glomerular hypofiltration syndrome may have a stronger predictive power for postcontrast AKI than creatinine‐based eGFR. Clinical relevance statement: Once the degree of kidney damage is established by estimating relative GFR (mL/min/1.73 m<sup>2</sup>), contrast dose in relation to renal excretion capacity [gram-iodine/absolute GFR (mL/min)] may be the best index to evaluate the risk of contrast-induced kidney injury. Key Points: • Relative glomerular filtration rate (GFR; mL/min/1.73 m <sup>2</sup>) should be used to assess the GFR category as a sign of the degree of kidney damage and sensitivity to contrast medium-induced acute kidney injury (CI-AKI). • Absolute GFR (mL/min) is the individual’s actual excretion capacity and the contrast-dose/absolute GFR ratio is a measure of systemic exposure (amount of contrast medium in the body), relates to toxicity and should be expressed in gram-iodine/absolute GFR (mL/min). • Prospective studies are warranted to evaluate the optimal contrast medium dose/GFR ratio predicting the risk of CI-AKI at CT and intra-arterial examinations.</p>}},
  author       = {{Nyman, Ulf and Leander, Peter and Liss, Per and Sterner, Gunnar and Brismar, Torkel}},
  issn         = {{0938-7994}},
  keywords     = {{Acute kidney injury; Angiography; Computed tomography; Contrast media; Glomerular filtration rate}},
  language     = {{eng}},
  publisher    = {{Springer}},
  series       = {{European Radiology}},
  title        = {{Absolute and relative GFR and contrast medium dose/GFR ratio : cornerstones when predicting the risk of acute kidney injury}},
  url          = {{http://dx.doi.org/10.1007/s00330-023-09962-w}},
  doi          = {{10.1007/s00330-023-09962-w}},
  year         = {{2023}},
}