GFR measurement in patients with CKD: Performance and feasibility of simplified iohexol plasma clearance techniques
Implementing shortened one-compartment iohexol plasma clearance models for GFR measurement is crucial since the gold standard inulin renal clearance technique and the reference two-compartment, 10-hour, 16-samplings iohexol plasma clearance method are clinically unfeasible. Inulin may precipitate an...
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| Veröffentlicht in: | PloS one 2024-07, Vol.19 (7), p.e0306935 |
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| creator | Carrara, Fabiola Gaspari, Flavio Trillini, Matias Peracchi, Tobia Fidone, Diego Stucchi, Nadia Ferrari, Silvia Cugini, Daniela Perico, Norberto Parvanova, Aneliya Remuzzi, Giuseppe Ruggenenti, Piero |
| description | Implementing shortened one-compartment iohexol plasma clearance models for GFR measurement is crucial since the gold standard inulin renal clearance technique and the reference two-compartment, 10-hour, 16-samplings iohexol plasma clearance method are clinically unfeasible. Inulin may precipitate anaphylactic shock. Four-hour and 8-hour one-compartment iohexol plasma clearance models with Bröchner-Mortensen correction provide accurate GFR measurements in patients with estimated GFR (eGFR) > or ≤40 mL/min/1.73m2, respectively. We compared the performance of the simplified 5-hour, 4-samplings, two-compartment population pharmacokinetic model (popPK) with the performance of the reference two-compartment 10-hour iohexol method in 16 patients with GFR 15.2 to 56.5 mL/min/1.73 m2. We also compared the performance of shortened (5, 6 and 7-hour) one-compartment models with the performance of the standard 8-hour one-compartment model in 101 patients with eGFR ≤40 mL/min/1.73 m2. The performance of popPK and shortened methods versus reference methods was evaluated by total deviation index (TDI), concordance correlation coefficient (CCC) and coverage probability (CP). TDI 90% indicated adequate performance. TDI, CCC and CP of popPK were 11.11%, 0.809 and 54.10%, respectively. All shortened, one-compartment models overestimated the GFR (p |
| doi_str_mv | 10.1371/journal.pone.0306935 |
| format | Article |
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Inulin may precipitate anaphylactic shock. Four-hour and 8-hour one-compartment iohexol plasma clearance models with Bröchner-Mortensen correction provide accurate GFR measurements in patients with estimated GFR (eGFR) > or ≤40 mL/min/1.73m2, respectively. We compared the performance of the simplified 5-hour, 4-samplings, two-compartment population pharmacokinetic model (popPK) with the performance of the reference two-compartment 10-hour iohexol method in 16 patients with GFR 15.2 to 56.5 mL/min/1.73 m2. We also compared the performance of shortened (5, 6 and 7-hour) one-compartment models with the performance of the standard 8-hour one-compartment model in 101 patients with eGFR ≤40 mL/min/1.73 m2. The performance of popPK and shortened methods versus reference methods was evaluated by total deviation index (TDI), concordance correlation coefficient (CCC) and coverage probability (CP). TDI <10%, CCC ≥0.9 and CP >90% indicated adequate performance. TDI, CCC and CP of popPK were 11.11%, 0.809 and 54.10%, respectively. All shortened, one-compartment models overestimated the GFR (p <0.0001 for all) as compared to the 8-hour model. TDI, CCC and CP were 7.02%, 0.815, and 75.80% for the 7-hour model, 7.26%, 0.803, and 74.20% for the 6-hour model, and 8.85%, 0.729 and 64.70% for the 5-hour model. The agreement of popPK model was comparable to that obtained with the Chronic-Kidney-Disease-Collaboration-Epidemiology (CKD-Epi) and the Modification-of-Diet-in-Renal-Disease (MDRD) serum-creatinine based equations for GFR estimation. PopPK model is remarkably unreliable for GFR measurement in stage III-IV CKD patients. In patients with eGFR ≤40 mL/min/1.73m2, shortened one-compartment models, in particular the 5-hour model, are less performant than the reference 8-hour model. For accurate GFR measurements, the iohexol plasma clearance should be measured with appropriate protocols. Over-simplified procedures should be avoided.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0306935</identifier><identifier>PMID: 39018289</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adult ; Aged ; Anaphylaxis ; Biology and Life Sciences ; Clinical medicine ; Comparative analysis ; Contrast media ; Contrast Media - pharmacokinetics ; Correlation coefficient ; Correlation coefficients ; Creatinine ; Engineering and Technology ; Epidemiology ; Epidermal growth factor receptors ; Feasibility Studies ; Female ; Glomerular Filtration Rate ; Humans ; Inulin ; Iohexol - analysis ; Iohexol - pharmacokinetics ; Kidney diseases ; Laboratories ; Male ; Measurement ; Medical research ; Medicine and Health Sciences ; Medicine, Experimental ; Metabolic Clearance Rate ; Methods ; Middle Aged ; Models, Biological ; Patients ; Performance evaluation ; Pharmacokinetics ; Plasma ; Renal Insufficiency, Chronic - blood ; Renal Insufficiency, Chronic - physiopathology ; Reproducibility ; Research centers</subject><ispartof>PloS one, 2024-07, Vol.19 (7), p.e0306935</ispartof><rights>Copyright: © 2024 Carrara et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</rights><rights>COPYRIGHT 2024 Public Library of Science</rights><rights>2024 Carrara et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2024 Carrara et al 2024 Carrara et al</rights><rights>2024 Carrara et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c526t-2cde8180e27eca194cc3b4d4e3b4e94be628ca3d2b19ff94c45683c488019ca63</cites><orcidid>0000-0002-5799-9535 ; 0000-0002-6194-3446 ; 0000-0003-1859-1729</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11253958/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11253958/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,724,777,781,861,882,2096,2915,23847,27905,27906,53772,53774,79349,79350</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39018289$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Burdmann, Emmanuel A.</contributor><creatorcontrib>Carrara, Fabiola</creatorcontrib><creatorcontrib>Gaspari, Flavio</creatorcontrib><creatorcontrib>Trillini, Matias</creatorcontrib><creatorcontrib>Peracchi, Tobia</creatorcontrib><creatorcontrib>Fidone, Diego</creatorcontrib><creatorcontrib>Stucchi, Nadia</creatorcontrib><creatorcontrib>Ferrari, Silvia</creatorcontrib><creatorcontrib>Cugini, Daniela</creatorcontrib><creatorcontrib>Perico, Norberto</creatorcontrib><creatorcontrib>Parvanova, Aneliya</creatorcontrib><creatorcontrib>Remuzzi, Giuseppe</creatorcontrib><creatorcontrib>Ruggenenti, Piero</creatorcontrib><title>GFR measurement in patients with CKD: Performance and feasibility of simplified iohexol plasma clearance techniques</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Implementing shortened one-compartment iohexol plasma clearance models for GFR measurement is crucial since the gold standard inulin renal clearance technique and the reference two-compartment, 10-hour, 16-samplings iohexol plasma clearance method are clinically unfeasible. Inulin may precipitate anaphylactic shock. Four-hour and 8-hour one-compartment iohexol plasma clearance models with Bröchner-Mortensen correction provide accurate GFR measurements in patients with estimated GFR (eGFR) > or ≤40 mL/min/1.73m2, respectively. We compared the performance of the simplified 5-hour, 4-samplings, two-compartment population pharmacokinetic model (popPK) with the performance of the reference two-compartment 10-hour iohexol method in 16 patients with GFR 15.2 to 56.5 mL/min/1.73 m2. We also compared the performance of shortened (5, 6 and 7-hour) one-compartment models with the performance of the standard 8-hour one-compartment model in 101 patients with eGFR ≤40 mL/min/1.73 m2. The performance of popPK and shortened methods versus reference methods was evaluated by total deviation index (TDI), concordance correlation coefficient (CCC) and coverage probability (CP). TDI <10%, CCC ≥0.9 and CP >90% indicated adequate performance. TDI, CCC and CP of popPK were 11.11%, 0.809 and 54.10%, respectively. All shortened, one-compartment models overestimated the GFR (p <0.0001 for all) as compared to the 8-hour model. TDI, CCC and CP were 7.02%, 0.815, and 75.80% for the 7-hour model, 7.26%, 0.803, and 74.20% for the 6-hour model, and 8.85%, 0.729 and 64.70% for the 5-hour model. The agreement of popPK model was comparable to that obtained with the Chronic-Kidney-Disease-Collaboration-Epidemiology (CKD-Epi) and the Modification-of-Diet-in-Renal-Disease (MDRD) serum-creatinine based equations for GFR estimation. PopPK model is remarkably unreliable for GFR measurement in stage III-IV CKD patients. In patients with eGFR ≤40 mL/min/1.73m2, shortened one-compartment models, in particular the 5-hour model, are less performant than the reference 8-hour model. For accurate GFR measurements, the iohexol plasma clearance should be measured with appropriate protocols. Over-simplified procedures should be avoided.</description><subject>Adult</subject><subject>Aged</subject><subject>Anaphylaxis</subject><subject>Biology and Life Sciences</subject><subject>Clinical medicine</subject><subject>Comparative analysis</subject><subject>Contrast media</subject><subject>Contrast Media - pharmacokinetics</subject><subject>Correlation coefficient</subject><subject>Correlation coefficients</subject><subject>Creatinine</subject><subject>Engineering and Technology</subject><subject>Epidemiology</subject><subject>Epidermal growth factor receptors</subject><subject>Feasibility Studies</subject><subject>Female</subject><subject>Glomerular Filtration Rate</subject><subject>Humans</subject><subject>Inulin</subject><subject>Iohexol - analysis</subject><subject>Iohexol - pharmacokinetics</subject><subject>Kidney diseases</subject><subject>Laboratories</subject><subject>Male</subject><subject>Measurement</subject><subject>Medical research</subject><subject>Medicine and Health Sciences</subject><subject>Medicine, Experimental</subject><subject>Metabolic Clearance Rate</subject><subject>Methods</subject><subject>Middle Aged</subject><subject>Models, Biological</subject><subject>Patients</subject><subject>Performance evaluation</subject><subject>Pharmacokinetics</subject><subject>Plasma</subject><subject>Renal Insufficiency, Chronic - 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Academic</collection><collection>ProQuest Engineering Collection</collection><collection>ProQuest Biological Science Collection</collection><collection>Agricultural Science Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biological Science Database</collection><collection>Engineering Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Advanced Technologies & Aerospace Database</collection><collection>ProQuest Advanced Technologies & Aerospace Collection</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Environmental Science Database</collection><collection>Materials Science Collection</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>Engineering Collection</collection><collection>Environmental Science Collection</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Carrara, Fabiola</au><au>Gaspari, Flavio</au><au>Trillini, Matias</au><au>Peracchi, Tobia</au><au>Fidone, Diego</au><au>Stucchi, Nadia</au><au>Ferrari, Silvia</au><au>Cugini, Daniela</au><au>Perico, Norberto</au><au>Parvanova, Aneliya</au><au>Remuzzi, Giuseppe</au><au>Ruggenenti, Piero</au><au>Burdmann, Emmanuel A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>GFR measurement in patients with CKD: Performance and feasibility of simplified iohexol plasma clearance techniques</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2024-07-17</date><risdate>2024</risdate><volume>19</volume><issue>7</issue><spage>e0306935</spage><pages>e0306935-</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Implementing shortened one-compartment iohexol plasma clearance models for GFR measurement is crucial since the gold standard inulin renal clearance technique and the reference two-compartment, 10-hour, 16-samplings iohexol plasma clearance method are clinically unfeasible. Inulin may precipitate anaphylactic shock. Four-hour and 8-hour one-compartment iohexol plasma clearance models with Bröchner-Mortensen correction provide accurate GFR measurements in patients with estimated GFR (eGFR) > or ≤40 mL/min/1.73m2, respectively. We compared the performance of the simplified 5-hour, 4-samplings, two-compartment population pharmacokinetic model (popPK) with the performance of the reference two-compartment 10-hour iohexol method in 16 patients with GFR 15.2 to 56.5 mL/min/1.73 m2. We also compared the performance of shortened (5, 6 and 7-hour) one-compartment models with the performance of the standard 8-hour one-compartment model in 101 patients with eGFR ≤40 mL/min/1.73 m2. The performance of popPK and shortened methods versus reference methods was evaluated by total deviation index (TDI), concordance correlation coefficient (CCC) and coverage probability (CP). TDI <10%, CCC ≥0.9 and CP >90% indicated adequate performance. TDI, CCC and CP of popPK were 11.11%, 0.809 and 54.10%, respectively. All shortened, one-compartment models overestimated the GFR (p <0.0001 for all) as compared to the 8-hour model. TDI, CCC and CP were 7.02%, 0.815, and 75.80% for the 7-hour model, 7.26%, 0.803, and 74.20% for the 6-hour model, and 8.85%, 0.729 and 64.70% for the 5-hour model. The agreement of popPK model was comparable to that obtained with the Chronic-Kidney-Disease-Collaboration-Epidemiology (CKD-Epi) and the Modification-of-Diet-in-Renal-Disease (MDRD) serum-creatinine based equations for GFR estimation. PopPK model is remarkably unreliable for GFR measurement in stage III-IV CKD patients. In patients with eGFR ≤40 mL/min/1.73m2, shortened one-compartment models, in particular the 5-hour model, are less performant than the reference 8-hour model. For accurate GFR measurements, the iohexol plasma clearance should be measured with appropriate protocols. Over-simplified procedures should be avoided.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>39018289</pmid><doi>10.1371/journal.pone.0306935</doi><tpages>e0306935</tpages><orcidid>https://orcid.org/0000-0002-5799-9535</orcidid><orcidid>https://orcid.org/0000-0002-6194-3446</orcidid><orcidid>https://orcid.org/0000-0003-1859-1729</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2024-07, Vol.19 (7), p.e0306935 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_3082199888 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Public Library of Science (PLoS); PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Adult Aged Anaphylaxis Biology and Life Sciences Clinical medicine Comparative analysis Contrast media Contrast Media - pharmacokinetics Correlation coefficient Correlation coefficients Creatinine Engineering and Technology Epidemiology Epidermal growth factor receptors Feasibility Studies Female Glomerular Filtration Rate Humans Inulin Iohexol - analysis Iohexol - pharmacokinetics Kidney diseases Laboratories Male Measurement Medical research Medicine and Health Sciences Medicine, Experimental Metabolic Clearance Rate Methods Middle Aged Models, Biological Patients Performance evaluation Pharmacokinetics Plasma Renal Insufficiency, Chronic - blood Renal Insufficiency, Chronic - physiopathology Reproducibility Research centers |
| title | GFR measurement in patients with CKD: Performance and feasibility of simplified iohexol plasma clearance techniques |
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