Nephrol Dial Transplant (1995) 10: 2274-2280
© 1995 European Renal Association-European Dialysis and Transplant Association
research-article
Time course of inulin and creatinine clearance in the interval between two haemodialysis treatments
1Renal Unit, Department of Medicine, Academic Medical Center, University of Amsterdam 2Clinical Chemistry, Academic Medical Center, University of Amsterdam
Correspondence and offprint requests to: Correspondence and offprint requests to: R. W. van Olden MD, Academic Medical Center, University of Amsterdam, Department of Nephrology, PO Box 22700, 1100 DE Amsterdam, The Netherlands
BACKGROUND: Urinary volume of haemodialysis patients with residual renal function increases during the interdialytic interval. The contribution of GFR to this change in water and solute excretion has not been quantified in detail. The creatinine clearance (Clc) as a determinant of the GFR may overestimate GFR caused by the tubular secretion of creatinine. Cimetidine has been used to inhibit the secretion of creatinine in non-dialysed patients. No data are available on its usefulness in haemodialysis patients.
METHODS: Two identical interdialytic intervals (DI) of 3 days (DI-1, DI-2) were investigated in 11 patients. The interval between DI-1 and DI-2 was 1 week. During DI-2 cimetidine 800 mg daily was administered. Each DI was divided in four urine-collection periods.
RESULTS: The water and solute excretion in DI-1 and DI-2 were similar. Urinary production increased from 0.37 ±0.30 ml/min to 0.66 ±0.33 ml/min (P<0.05), inulin clearance (C11) increased from 1.8±1.1 ml/min to 2.7 ± 1.2 ml/min (P<0.05), fractional sodium excretion from 9.0 ± 5.7% to 14.5 ± 9.0% (P<0.05). In contrast to Cli;; the Clc showed no increase during the interdialytic interval both in DI-1 and DI-2. The overestimation of GFR by creatinine (Cli – Cli) decreased during DI-1 from 1.35 ±1.69 ml/min to 0.26 ± 0.60 (P<0.05) and during DI-2 from 1.01 ±1.33 ml/min to 0.10 ± 0.67 (P<0.01). The ratio Clc/Cli decreased during DI-1 from 1.78 ± 0.53 to 1.09 ± 0.19 (P< 0.01) and during DI-2 from 2.02 ±1.13 to 1.05 ± 0.30 (P<0.01). All parameters were not different between the comparable days of DI-1 and DI-2.
CONCLUSION: We conclude that the urinary volume in the interdialytic interval is directly related to changes in GFR. During the interdialytic interval GFR increased and tubular secretion of creatinine decreased. The administration of cimetidine did not improve the accuracy of Clc as a measurement of GFR in end-stage renal failure.
Keywords: cimetidine; creatinine clearance; haemodialysis; inulin clearance; interdialytic interval; residual renal function
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