Iohexol plasma clearance for measuring glomerular filtration rate in clinical practice and research: a review. Part 2: Why to measure glomerular filtration rate with iohexol?
A reliable assessment of glomerular filtration rate (GFR) is of paramount importance in clinical practice as well as epidemiological and clinical research settings. It is recommended by Kidney Disease: Improving Global Outcomes guidelines in specific populations (anorectic, cirrhotic, obese, renal and non-renal transplant patients) where estimation equations are unreliable. Measured GFR is the only valuable test to confirm or confute the status of chronic kidney disease (CKD), to evaluate the slope of renal function decay over time, to assess the suitability of living kidney donors and for dosing of potentially toxic medication with a narrow therapeutic index. Abnormally elevated GFR or hyperfiltration in patients with diabetes or obesity can be correctly diagnosed only by measuring GFR. GFR measurement contributes to assessing the true CKD prevalence rate, avoiding discrepancies due to GFR estimation with different equations. Using measured GFR, successfully accomplished in large epidemiological studies, is the only way to study the potential link between decreased renal function and cardiovascular or total mortality, being sure that this association is not due to confounders, i.e. non-GFR determinants of biomarkers. In clinical research, it has been shown that measured GFR (or measured GFR slope) as a secondary endpoint as compared with estimated GFR detected subtle treatment effects and obtained these results with a comparatively smaller sample size than trials choosing estimated GFR. Measuring GFR by iohexol has several advantages: simplicity, low cost, stability and low interlaboratory variation. Iohexol plasma clearance represents the best chance for implementing a standardized GFR measurement protocol applicable worldwide both in clinical practice and in research.
Department of Nephrology, Dialysis and Transplantation , University of Liège Hospital (ULg CHU) , 4000 Liège , Belgium.
Pierre
P
Delanaye
Metabolic and Renal Research Group , UiT The Arctic University of Norway and Section of Nephrology, University Hospital of North Norway , Tromsø , Norway.
Toralf
T
Melsom
Charité University Medicine, Institute of Public Health, Berlin , Germany.
Natalie
N
Ebert
Department of Clinical Chemistry , Skåne University Hospital , Lund , Sweden.
Sten-Erik
SE
Bäck
Department of Nephrology, Dialysis, Transplantation and Hypertension , CHU Hôpital Nord, University Jean Monnet, PRES Université de LYON , Saint-Etienne , France.
Christophe
C
Mariat
Department of Clinical Chemistry , University of Liège Hospital (ULg CHU) , Liège , Belgium.
Etienne
E
Cavalier
Department of Occupational and Environmental Medicine , Lund University , Lund , Sweden.
Jonas
J
Björk
Department of Nephrology , Skåne University Hospital , Lund , Sweden.
Anders
A
Christensson
Department of Translational Medicine, Division of Medical Radiology , Skåne University Hospital , Malmö , Sweden.
Ulf
U
Nyman
University of La Laguna, CIBICAN-ITB, Faculty of Medicine, Hospital Universtario de Canarias , Tenerife , Spain.
Esteban
E
Porrini
Centro di Ricerche Cliniche per le Malattie Rare 'Aldo e Cele Daccò', Istituto di Ricerche Farmacologiche Mario Negri, Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Bergamo, Italy; Unit of Nephrology, Azienda Socio Sanitaria Territoriale (ASST) Ospedale Papa Giovanni XXIII, Bergamo, Italy.
Giuseppe
G
Remuzzi
Centro di Ricerche Cliniche per le Malattie Rare 'Aldo e Cele Daccò', Istituto di Ricerche Farmacologiche Mario Negri, Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Bergamo, Italy; Unit of Nephrology, Azienda Socio Sanitaria Territoriale (ASST) Ospedale Papa Giovanni XXIII, Bergamo, Italy.
Piero
P
Ruggenenti
Charité University Medicine, Institute of Public Health, Berlin , Germany.
Elke
E
Schaeffner
Department of Medical Sciences , Uppsala University , Uppsala , Sweden.
Inga
I
Soveri
Department of Nephrology , Skåne University Hospital , Malmö , Sweden.
Gunnar
G
Sterner
Metabolic and Renal Research Group , UiT The Arctic University of Norway and Section of Nephrology, University Hospital of North Norway , Tromsø , Norway.
Bjørn Odvar
BO
Eriksen
IRCCS - Istituto di Ricerche Farmacologiche 'Mario Negri', Centro di Ricerche Cliniche per le Malattie Rare 'Aldo e Cele Daccò', Ranica, Bergamo, Italy.
Flavio
F
Gaspari
glomerular filtration rate; iohexol
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