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Iohexol clearance in unstable critically ill patients: a tool to assess glomerular filtration rate

  • Charlotte Salmon-Gandonnière EMAIL logo , Isabelle Benz-de Bretagne , Emmanuelle Mercier , Aurélie Joret , Jean-Michel Halimi , Stephan Ehrmann and Chantal Barin-Le Guellec
Published/Copyright: May 11, 2016
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Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 54 Issue 11

Abstract

Background:

Acute kidney injury (AKI) is associated with significant morbidity and mortality, particularly in unstable critically ill patients. In this context, serum creatinine concentration is an imperfect tool for estimating glomerular filtration rate (GFR), an index of renal function. The objective of this pilot study was to evaluate the feasibility of measuring iohexol clearance for GFR assessment in critically ill patients with acute circulatory failure at intensive care unit (ICU) admission.

Methods:

ICU patients were prospectively included within 12 h of acute circulatory failure; a non-toxic dose of iohexol (5 mL) was infused intravenously and iohexol plasma concentration decrease was measured over 24 h. Urinary iohexol concentration was measured in urine samples collected four times, every 6 h for 24 h. The Kidney Disease Improving Global Outcome score, measuring AKI, was calculated each day.

Results:

Among 18 patients with acute circulatory failure, AKI developed in 15; 14 showed decreased serum creatinine concentration during the first 24 h even though 10 presented AKI. The absolute variation in serum creatinine concentration was correlated with fluid balance over 24 h. Median [min; max] plasma clearance of iohexol was 39.4 mL/min [6.1; 154.0] and iohexol urinary clearance 32.8 mL/min [0.8–170.4]. The correlation between plasma and urinary clearance was ρ=0.97, p<0.0001.

Conclusions:

GFR may be estimated by plasma iohexol clearance in unstable critically ill patients. This method is reliable, correlates very well with urinary iohexol clearance and does not depend on input/output fluid balance and fluid infusion, as compared with serum creatinine concentration.

Keywords: acute kidney injury; glomerular filtration rate; intensive care units; iohexol; pharmacokinetics; shock

Acknowledgments:

We thank the study nurses of the réanimation polyvalente department of Tours university hospital center: Christine Mabilat, Véronique Siméon-Vieules and Aurélie Aubrey. We also express our gratitude to Marie Leclerc, clinical research assistant, and to the biochemistry technicians who performed the iohexol measurements. We thank Laura Smales for the English editing.

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: The authors acknowledge receipt of a grant “Bourse de Recherche Clinique” from the French society of intensive care “Société de Réanimation de Langue Française” (www.srlf.org) for the conduct of this study.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

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Received: 2015-12-5
Accepted: 2016-3-28
Published Online: 2016-5-11
Published in Print: 2016-11-1

©2016 Walter de Gruyter GmbH, Berlin/Boston

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https://doi.org/10.1515/cclm-2015-1202
Keywords for this article
acute kidney injury; glomerular filtration rate; intensive care units; iohexol; pharmacokinetics; shock

Articles in the same Issue

  1. Frontmatter
  2. Editorials
  3. CCLM Award for the Most Cited Paper Recently Published
  4. Laboratory economics. Risk or opportunity?
  5. Reviews
  6. Molecular diagnosis and precision medicine in allergy management
  7. The insulin autoimmune syndrome (IAS) as a cause of hypoglycaemia: an update on the pathophysiology, biochemical investigations and diagnosis
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  10. Genetics and Molecular Diagnostics
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  18. Iohexol clearance in unstable critically ill patients: a tool to assess glomerular filtration rate
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