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NDT Advance Access originally published online on August 3, 2007
Nephrology Dialysis Transplantation 2007 22(11):3166-3173; doi:10.1093/ndt/gfm411
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© The Author [2007]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org


GFR determination in adults with a single-sample iohexol plasma clearance method based on the mean sojourn time

Margareta Gref and Kjell Karp

Department of Clinical Physiology, Institution of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden

Correspondence and offprint requests to: Margareta Gref, Department of Clinical Physiology, Norrland University Hospital, S-901 85 Umeå, Sweden. Email: Margareta.Gref{at}vll.se



  Abstract

Background. Glomerular filtration rate is a key parameter in kidney disease. The Radionuclides in Nephrourology Committee has recommended a single-sample method with 99mTc-DTPA based on the mean sojourn time. This study was done to develop the method for use with iohexol making the method more available.

Methods. The single-sample formula was derived for group I (n = 48, Cl = 8–188 ml/min) and applied on group II (n = 47) and on group III (n = 123). In groups I and II, reference clearance was determined according to Sapirstein and in group III according to Brøchner-Mortensen.

Results. The formula Formula (a = (–6.49 x 10–6xt + 8.85 x 10–4)xt, b = 1.143 x t and c = ln[(C(t))x(ECV/Q0)](ECV) was derived for patients with estimated Cl > 30 ml/min with the best result if the single sample was obtained between 4 and 5 h. Extracellular volume was estimated as ECV =9985 x BSA – 3431.

The formula ClS(24 h) = –ln[(C(t))x(ECV/Q0)](ECV)/(t) was developed for patients with estimated Cl <30 ml/min with a single sample at 24 h. With this combined approach SDdiff was 2.7 ml/min in group II and 3.1 ml/min in group III.

Conclusions. An accurate determination of iohexol clearance can be obtained from a single plasma sample applying the mean sojourn time approach. A separate formula must be used for patients with low clearance values. Body surface area (BSA), injected amount of iohexol (Q0), time when the single sample is drawn (t) and the concentration of iohexol [C(t)] in the sample are needed for the calculations.

Keywords: glomerular filtration rate; iohexol clearance; renal function; single sample; 24 h sample

Received for publication: 28. 6.06
Accepted in revised form: 31. 5.07


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