Nephrology Dialysis Transplantation, Vol 14, Issue 5 1247-1251, Copyright © 1999 by Oxford University Press
F Kempermann, J Silberbusch, E Slaats, A van Zanten, J Weber, R Krediet and L Arisz
Background. Estimation of glomerular filtration rate
(GFR) from plasma creatinine concentration after inhibition of tubular
creatinine secretion with cimetidine provides a good assessment in patients
with various nephropathies and with non-insulin-dependent diabetes mellitus
(NIDDM). The aim of this study was to compare cimetidine-aided GFR
estimations using various creatinine assays. Methods.
In 30 outpatients with NIDDM GFR was measured as the urinary
clearance of continuously infused [125I]iothalamate.
Plasma creatinine concentration was analysed after oral cimetidine with an
alkaline picrate (AP) method, with an enzymatic (PAP) assay and with HPLC.
GFR estimations were calculated with the Cockcroft-Gault formula (CG)
Results. AP creatinine concentrations were
significantly higher than PAP or HPLC values. GFR estimations by AP (CGAP
66±19 ml/min/1.73 m2, mean±SD)
were significantly lower than GFR (89±30), whereas
CGPAP(85±30) and CGHPLC (84±34 ml/min/1.73
m2) were not. Bland and Altman analysis showed a
difference between CGAP and GFR of -22.4±17.7 ml/min/1.73
m2, this difference becomes larger when the GFR
increases. The difference between CG and GFR was only -3.8±14.8
ml/min/1.73 m2 for PAP and -4.4±17.5
ml/min/1.73 m2 for HPLC, without any systematic
difference. Conclusion. A good assessment of the GFR
from plasma creatinine after cimetidine administration is possible when
creatinine is measured with an enzymatic assay or with the less convenient
HPLC method. The more widespread and cheaper alkaline picrate assay is not
suitable for GFR-estimation. Keywords: cimetidine;
Cockroft and Gault formula; creatinine assay; GFR; NIDDM; tubular secretion
TECHNICAL REPORT
Glomerular filtration rate estimation from plasma creatinine after inhibition of tubular secretion: relevance of the creatinine assay
Departments of Internal Medicine and Clinical Chemistry of the Hospital Onze Lieve Vrouwe Gasthuis, Clinical Chemistry of the Slotervaars Hospital, Clinical Chemistry and Internal Medicine of the Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands; Corresponding author address: Academic Medical Centre, University of Amsterdam, Department of Nephrology, F4-215, PO Box 22700, 1100 DE Amsterdam, The Netherlands
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