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Comparison of iohexol plasma clearance formulas vs. inulin urinary clearance for measuring glomerular filtration rate

  • Laurence Dubourg , Sandrine Lemoine , Brune Joannard , Laurence Chardon , Vandréa de Souza , Pierre Cochat , Jean Iwaz , Muriel Rabilloud and Luciano Selistre ORCID logo EMAIL logo
Published/Copyright: October 19, 2020
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Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 59 Issue 3

Abstract

Objectives

The one-compartment iohexol plasma clearance has been proposed as a reliable alternative to renal inulin clearance. However, this method’s performance depends on the formula used to calculate glomerular filtration rate (GFR). This study reports on performance comparisons between various mathematical formulas proposed for iohexol plasma clearance vs. inulin urinary clearance.

Methods

GFR was simultaneously determined by inulin and iohexol clearance in 144 participants (age: 10–84 years; glomerular filtration rate: 15–169 mL/min/1.73 m2). A retrospective cross-sectional study evaluated the performance of four formulas proposed to calculate plasma iohexol clearance (Brøchner–Mortensen, Fleming et al., Jødal–Brøchner–Mortensen, and Ng–Schwartz–Munoz). The performance of each formula was assessed using bias, precision (standard deviation of the bias), accuracy (percentage iohexol within 5, 10, and 15%), root mean square error, and concordance correlation coefficient vs. renal inulin clearance as reference.

Results

Regarding accuracy, there was no difference in root mean square error (RMSE), P5, P10, or P15 between the four formulas. The four concordance correlation coefficients (CCC) between the value from each formula and in-GFR were high and not significantly different. At in-GFR ≥90 mL/min/1.73 m2, Ng–Schwartz–Munoz formula performed slightly better than other formulas regarding median bias (−0.5; 95% CI [−3.0 to 2.0] and accuracy P15 (95.0; 95% CI [88.0–100.0]).

Conclusions

The studied formulas were found equivalent in terms of precision and accuracy, but the Ng–Schwartz–Munoz formula improved the accuracy at higher levels of in-GFR.

Keywords: clearance of iohexol; clearance of inulin; glomerular filtration rate; renal function
Corresponding author: Luciano da Silva Selistre, MD, PhD, Néphrologie, Dialyse, Hypertension et Exploration Fonctionnelle Rénale, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Universidade de Caxias do Sul,Rua Francisco Getúlio Vargas, 1130, ZIP 95070-560, Caxias do Sul, Brazil; CAPES Foundation, Ministry of Education of Brazil, Brasilia, Brazil; and Hospital Geral de Caxias do Sul, Caxias do Sul, Brasil, Phone: (+33) 472119117, E-mail:

Funding source: Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

Award Identifier / Grant number: 88881.156638/2017-01

  1. Research funding: The study had no specific public or private financial support. During the period of analysis and publication, author Luciano Selistre benefited from a grant from the Brazilian government (CAPES Foundation, Ministry of Education of Brazil, grant number: 88881.156638/2017-01). CAPES Foundation had no roles in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

  2. Author contributions: LS and LD had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: LS, VS, SL, MR, and LD. Acquisition of data: LS, LD, BJ, LD, SL, and PC. Analysis and interpretation of data: LS, MR, LD, and VS. Critical revision of the manuscript for important intellectual content: LS, VS, JI, MR, and LD. Administrative, technical, or material support: LS and LD. All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Authors state no conflict of interest.

  4. Data availability: Authors Luciano Selistre and Laurence Dubourg had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. The data may be accessed through: dataverse.harvard.edu/dataset.xhtml?persistentId=doi:10.7910/DVN/SKSPSY.

  5. Informed consent: Informed consent was obtained from all individuals included in this study.

  6. Ethical approval: All procedures were carried out in accordance with the ethical standards of the institution, the 2013 Helsinki Declaration and its later amendments, or with comparable ethical standards.

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Received: 2020-05-22
Accepted: 2020-09-28
Published Online: 2020-10-19
Published in Print: 2021-02-23

© 2020 Walter de Gruyter GmbH, Berlin/Boston

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https://doi.org/10.1515/cclm-2020-0770
Keywords for this article
clearance of iohexol; clearance of inulin; glomerular filtration rate; renal function

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Complex analytical procedures in diagnostic laboratories and the IVDR
  4. Review
  5. Re-examining ferritin-bound iron: current and developing clinical tools
  6. Opinion Papers
  7. Designing a diagnostic Total Testing Process as a base for supporting diagnostic stewardship
  8. The end of the laboratory developed test as we know it? Recommendations from a national multidisciplinary taskforce of laboratory specialists on the interpretation of the IVDR and its complications
  9. EFLM Papers
  10. The Academy of the European Federation of Clinical Chemistry and Laboratory Medicine and the European Register of Specialists in Laboratory Medicine: guide to the Academy and the Register, version 4 – 2020
  11. A proposed Common Training Framework for Specialists in Laboratory Medicine under EU Directive 2013/55/EC (The Recognition of Professional Qualifications)
  12. Guidelines and Recommendations
  13. High-sensitivity cardiac troponin I and T methods for the early detection of myocardial injury in patients on chemotherapy
  14. General Clinical Chemistry and Laboratory Medicine
  15. Measurement of serum 17-hydroxyprogesterone using isotope dilution liquid chromatography-tandem mass spectrometry candidate reference method and evaluation of the performance for three routine methods
  16. Evaluation of carbohydrate-deficient transferrin measurements on the V8 capillary electrophoresis system and comparison with the IFCC approved HPLC reference method and N-Latex immunonephelometric assay
  17. The clinical relevance of anti-dsDNA antibodies determined by the Elia™ dsDNA assay in patients with negative indirect immunofluorescence on the HEp-2 cell
  18. A hierarchical bivariate meta-analysis of diagnostic test accuracy to provide direct comparisons of immunoassays vs. indirect immunofluorescence for initial screening of connective tissue diseases
  19. Individual uromodulin serum concentration is independent of glomerular filtration rate in healthy kidney donors
  20. Comparison of iohexol plasma clearance formulas vs. inulin urinary clearance for measuring glomerular filtration rate
  21. Overweight-obesity is associated with decreased vitamin K2 levels in hemodialysis patients
  22. Cardiovascular Diseases
  23. Evaluating the performance of an updated high-sensitivity troponin T assay with increased tolerance to biotin
  24. Infectious Diseases
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  26. Quantification of the HIV-1 total reservoir in the peripheral blood of naïve and treated patients by a standardised method derived from a commercial HIV-1 RNA quantification assay
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