A Novel Method for Rapid Bedside Measurement of GFR

Rizk, Dana V.; Meier, Daniel; Sandoval, Ruben M.; Chacana, Teresa; Reilly, Erinn S.; Seegmiller, Jesse C.; DeNoia, Emmanuel; Strickland, James S.; Muldoon, Joseph P.; Molitoris, Bruce A.

doi:10.1681/asn.2018020160

Cited by 49 publications

(44 citation statements)

References 16 publications

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“…mGFR is the gold standard for the assessment of kidney function. Most recently, Dana V. Rizk et al reported a novel and rapid technique for direct GFR measurement using visible fluorescent injectate [ 41 ]. However, some studies reported that mGFR has a much higher coefficient of variation than endogenous filtration markers, indicating that biological variations and measurement errors exist [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

Upper Normal Serum Creatinine Concentrations as a Predictor for Chronic Kidney Disease: Analysis of 14 Years’ Korean Genome and Epidemiology Study (KoGES)

Jhee¹,

Hwang²,

Song³

et al. 2018

JCM

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Both serum creatinine (sCr) and estimated glomerular filtration rate (eGFR) have been used to assess kidney function in public health check-ups. However, when the sCr is within the normal levels but the eGFR is <60 mL/min/1.73 m2, a dilemma arises, as the patients might progress to chronic kidney disease (CKD) after several years. We aimed to evaluate the association between normal sCr and the risk of incident CKD in the general population. For this, 9445 subjects from the Korean Genome and Epidemiology Study, with normal sCr and eGFR of >60 mL/min/1.73 m2 were analyzed. The subjects were classified into quartiles based on sCr levels. The primary outcome was the development of eGFR <60 mL/min/1.73 m2 on two consecutive measures. During a mean follow-up of 8.4 ± 4.3 years, 779 (8.2%) subjects developed eGFR <60 mL/min/1.73 m2. The incidence of the development of eGFR <60 mL/min/1.73 m2 was higher in the higher quartiles than in the lowest quartile. In multivariable Cox analysis, the highest quartile was associated with an increased risk for the development of eGFR <60 mL/min/1.73 m2 (hazard ratio (HR), 4.71; 95% confidence interval (CI), 3.29–6.74 in females; HR, 12.77; 95% CI, 7.69–21.23 in males). In the receiver operating characteristic curve analysis, adding sCr to the traditional risk factors for CKD improved the accuracy of predicting the development of eGFR <60 mL/min/1.73 m2 (area under the curve, 0.83 vs. 0.80 in females and 0.85 vs. 0.78 in males), and the cutoff value of sCr was 0.75 mg/dL and 0.78 mg/dL in females and males. Cautious interpretation is necessary when sCr is within the normal range, considering that the upper normal range of sCr has a higher risk of CKD development.

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Section: Discussionmentioning

confidence: 99%

Upper Normal Serum Creatinine Concentrations as a Predictor for Chronic Kidney Disease: Analysis of 14 Years’ Korean Genome and Epidemiology Study (KoGES)

Jhee¹,

Hwang²,

Song³

et al. 2018

JCM

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“…Rizk et al developed a novel method for rapid bedside GFR measurements that beats creatinine and cystatin C 13 . Simultaneously, the authors estimated effective plasma volume.…”

Section: Glomerular Filtration Rate and Other Markersmentioning

confidence: 99%

Biomarkers and predicting acute kidney injury

Luft

2020

Acta Physiologica

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Aim How can we convert biomarkers into reliable, validated laboratory tests? Glomerular filtration rate (GFR) estimators exist for more than a century. The first utilitarian biomarkers were endogenously produced urea and creatinine. Clinicians then developed simple tests to determine whether or not renal tubular function was maintained. Are there faster and better tests that reflect decreased renal function and increased acute kidney injury (AKI) risk? Methods We inspect earlier, and recently propagated biomarkers. Cystatin C reflects GFR and is not confounded by muscle mass. Direct GFR and plasma volume can now be measured acutely within 3 hours. Better yet would be tests that give information before GFR decreases and prior to urea, creatinine, and cystatin C increases. Prospective tests identifying those persons likely to develop AKI would be helpful. Even more utilitarian would be a test that also suggests a therapeutic avenue. Results A number of highly provocative biomarkers have recently been proposed. Moreover the application of big data from huge electronic medical records promise new directions in identifying and dealing with AKI. Conclusions Pipedreams are in the pipeline; the novel findings require immediate testing, verification, and perhaps application. Future research promises to make such dreams come true.

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“…Moreover, because of recent advances in technology, it has become possible to measure the fluorescence of plasma dextrans at the level of the skin capillaries without the need for blood samples. 33,35,36 Although this approach promises a fast, simple, and continuous measurement of GFR, at present it is available only in animal models and several issues remain to be assessed before clinical implementation (Figure 2). However, the reader can easily imagine the usefulness of their implementation in oncological settings.…”

Section: Assessment Of Renal Function In Akimentioning

confidence: 99%