Iohexol plasma clearance for measuring glomerular filtration rate in clinical practice and research: a review. Part 1: How to measure glomerular filtration rate with iohexol?
While there is general agreement on the necessity to measure glomerular filtration rate (GFR) in many clinical situations, there is less agreement on the best method to achieve this purpose. As the gold standard method for GFR determination, urinary (or renal) clearance of inulin, fades into the background due to inconvenience and high cost, a diversity of filtration markers and protocols compete to replace it. In this review, we suggest that iohexol, a non-ionic contrast agent, is most suited to replace inulin as the marker of choice for GFR determination. Iohexol comes very close to fulfilling all requirements for an ideal GFR marker in terms of low extra-renal excretion, low protein binding and in being neither secreted nor reabsorbed by the kidney. In addition, iohexol is virtually non-toxic and carries a low cost. As iohexol is stable in plasma, administration and sample analysis can be separated in both space and time, allowing access to GFR determination across different settings. An external proficiency programme operated by Equalis AB, Sweden, exists for iohexol, facilitating interlaboratory comparison of results. Plasma clearance measurement is the protocol of choice as it combines a reliable GFR determination with convenience for the patient. Single-sample protocols dominate, but multiple-sample protocols may be more accurate in specific situations. In low GFRs one or more late samples should be included to improve accuracy. In patients with large oedema or ascites, urinary clearance protocols should be employed. In conclusion, plasma clearance of iohexol may well be the best candidate for a common GFR determination method.
Department of Nephrology, Dialysis and Transplantation , University of Liège Hospital (ULg CHU) , Liège , Belgium.
Pierre
P
Delanaye
Charité University Medicine , Institute of Public Health , Berlin , Germany.
Natalie
N
Ebert
Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway; Section of Nephrology, University Hospital of North Norway, Tromsø, Norway.
Toralf
T
Melsom
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
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, La Laguna, 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, Tromsø, Norway; Section of Nephrology, University Hospital of North Norway, Tromsø, Norway.
Bjørn Odvar
BO
Eriksen
Department of Clinical Chemistry , Skåne University Hospital , Lund , Sweden.
Sten-Erik
SE
Bäck
glomerular filtration rate; iohexol
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