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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?

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          While there is general agreement on the necessity to measure glomerular filtration rate (GFR) in many clinical situations, there is less agreement on the best method to achieve this purpose. As the gold standard method for GFR determination, urinary (or renal) clearance of inulin, fades into the background due to inconvenience and high cost, a diversity of filtration markers 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 GFR marker 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, but multiple-sample protocols may be more accurate in specific situations. In low GFRs one or more 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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          Predictive performance of the modification of diet in renal disease and Cockcroft-Gault equations for estimating renal function.

          Recent recommendations emphasize the need to assess kidney function using creatinine-based predictive equations to optimize the care of patients with chronic kidney disease. The most widely used equations are the Cockcroft-Gault (CG) and the simplified Modification of Diet in Renal Disease (MDRD) formulas. However, they still need to be validated in large samples of subjects, including large non-U.S. cohorts. Renal clearance of (51)Cr-EDTA was compared with GFR estimated using either the CG equation or the MDRD formula in a cohort of 2095 adult Europeans (863 female and 1232 male; median age, 53.2 yr; median measured GFR, 59.8 ml/min per 1.73 m(2)). When the entire study population was considered, the CG and MDRD equations showed very limited bias. They overestimated measured GFR by 1.94 ml/min per 1.73 m(2) and underestimated it by 0.99 ml/min per 1.73 m(2), respectively. However, analysis of subgroups defined by age, gender, body mass index, and GFR level showed that the biases of the two formulas could be much larger in selected populations. Furthermore, analysis of the SD of the mean difference between estimated and measured GFR showed that both formulas lacked precision; the CG formula was less precise than the MDRD one in most cases. In the whole study population, the SD was 15.1 and 13.5 ml/min per 1.73 m(2) for the CG and MDRD formulas, respectively. Finally, 29.2 and 32.4% of subjects were misclassified when the CG and MDRD formulas were used to categorize subjects according to the Kidney Disease Outcomes Quality Initiative chronic kidney disease classification, respectively.
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                Author and article information

                Clin Kidney J
                Clin Kidney J
                Clinical Kidney Journal
                Oxford University Press
                October 2016
                23 August 2016
                23 August 2016
                : 9
                : 5
                : 682-699
                [1 ]Department of Nephrology, Dialysis and Transplantation, University of Liège Hospital (ULg CHU) , Liège, Belgium
                [2 ]Charité University Medicine , Institute of Public Health , Berlin, Germany
                [3 ]Metabolic and Renal Research Group, UiT The Arctic University of Norway , Tromsø, Norway
                [4 ]Section of Nephrology, University Hospital of North Norway , Tromsø, Norway
                [5 ]IRCCS - Istituto di Ricerche Farmacologiche ‘Mario Negri’, Centro di Ricerche Cliniche per le Malattie Rare ‘Aldo e Cele Daccò’, Ranica, Bergamo, Italy
                [6 ]Department of Nephrology, Dialysis, Transplantation and Hypertension, CHU Hôpital Nord, University Jean Monnet, PRES Université de LYON , Saint-Etienne, France
                [7 ]Department of Clinical Chemistry, University of Liège Hospital (ULg CHU) , Liège, Belgium
                [8 ]Department of Occupational and Environmental Medicine, Lund University , Lund, Sweden
                [9 ]Department of Nephrology, Skåne University Hospital , Lund, Sweden
                [10 ]Department of Translational Medicine, Division of Medical Radiology, Skåne University Hospital , Malmö, Sweden
                [11 ]University of La Laguna, CIBICAN-ITB, Faculty of Medicine, Hospital Universtario de Canarias, La Laguna, Tenerife, Spain
                [12 ]Centro di Ricerche Cliniche per le Malattie Rare ‘Aldo e Cele Daccò, Istituto di Ricerche Farmacologiche Mario Negri, Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso , Bergamo, Italy
                [13 ]Unit of Nephrology, Azienda Socio Sanitaria Territoriale (ASST) Ospedale Papa Giovanni XXIII , Bergamo, Italy
                [14 ]Department of Medical Sciences, Uppsala University , Uppsala, Sweden
                [15 ]Department of Nephrology, Skåne University Hospital , Malmö, Sweden
                [16 ]Department of Clinical Chemistry, Skåne University Hospital , Lund, Sweden
                Author notes
                Correspondence and offprint requests to: Pierre Delanaye; E-mail: pierre_delanaye@ 123456yahoo.fr
                © The Author 2016. Published by Oxford University Press on behalf of ERA-EDTA.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

                Measuring Gfr


                glomerular filtration rate, iohexol


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