Accurate measurement of extracellular fluid volume from the slope/intercept technique after bolus injection of a filtration marker.
Extracellular fluid volume (ECV) is studied infrequently. The zero-time distribution volume (Vd) generated in the slope-intercept technique for measuring the glomerular filtration rate (GFR) substantially overestimates ECV. The aim was to validate a new technique for measuring ECV from the slope-intercept approach. GFR and ECV were measured using Cr-51-EDTA and iohexol injected into opposite arms in 51 patients undergoing routine measurement of GFR and on 48 occasions in 20 healthy volunteers. Blood samples were obtained bilaterally 20, 40, 60, 120, 180 and 240 min post-injection and assayed for indicator injected contralaterally. Reference ECV (ECV6) was calculated from all six samples as the product of indicator transit time and multi-sample GFR. GFR/ECV was calculated as the rate constant of the exponential fitted to the last three samples (GFR/ECV3). Slope-intercept GFR was calculated from the last three samples using the slope-intercept technique (GFR3). ECV (ECV3) was calculated by dividing GFR3 by GFR/ECV3, having corrected both for their one-compartment assumptions. ECV6(EDTA) correlated closely with ECV3(EDTA) (ECV3(EDTA) = 1.01.ECV6(EDTA)-0.5 L; r = 0.97; n = 99), but less closely with Vd (Vd = 1.17.ECV6(EDTA) + 0.7 L; r = 0.86). ECV6(iohexol) correlated slightly better with ECV6 (EDTA) (ECV6(EDTA) = 0.81.ECV6(iohexol) + 3.3 L; r = 0.86) than with ECV3(EDTA) (ECV3(EDTA) = 0.83.ECV6(iohexol) + 2.9 L; r = 0.84) and had slightly narrower 95% limits of agreement (-3.82 and 2.82 L versus -3.90 to 3.43 L). In conclusion, ECV can be measured from three samples almost as accurately as ECV from multiple samples.
Department of Nuclear Medicine, Addenbrooke's Hospital, Cambridge, UK.
Nicholas J
NJ
Bird
A Robert
AR
Michell
A Michael
AM
Peters
D000465:Algorithms; D001132:Arm; D002860:Chromium Radioisotopes / Q000097:blood / Q000493:pharmacokinetics; D019937:Diagnostic Techniques and Procedures; D004492:Edetic Acid / Q000097:blood / Q000493:pharmacokinetics; D045604:Extracellular Fluid; D005919:Glomerular Filtration Rate; D006801:Humans; D007472:Iohexol / Q000493:pharmacokinetics; D008297:Male; D010949:Plasma / Q000378:metabolism; D012044:Regression Analysis; D015203:Reproducibility of Results; D013997:Time Factors
D002860:Chromium Radioisotopes; D007472:Iohexol; D004492:Edetic Acid