A Practical Method of Measuring Glomerular Filtration Rate by Iohexol Clearance Using Dried Capillary Blood Spots

Mafham, Marion; Niculescu-Duvaz, Ioana; Barron, Jeffrey; Emberson, Jonathan; Dockrell, Mark E. C.; Landray, Martin J; Baigent, Colin

doi:10.1159/000102997

Cited by 23 publications

(19 citation statements)

References 35 publications

(26 reference statements)

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“…The C&G equation was selected to assess renal function in this study because it is more accurate than the Modification of Diet in Renal Disease (MDRD) equation when used to assess mild renal insufficiency (27). It was further corrected by body surface area.…”

Section: Methodsmentioning

confidence: 99%

Risk Factors for Metabolic Syndrome Independently Predict Arterial Stiffness and Endothelial Dysfunction in Patients With Chronic Kidney Disease and Minimal Comorbidity

Lilitkarntakul

Dhaun²,

Melville³

et al. 2012

Diabetes Care

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OBJECTIVEMetabolic syndrome (MS) is common in patients with chronic kidney disease (CKD), but its contribution to arterial stiffness and endothelial dysfunction in CKD is not well defined. We hypothesized that risk factors for MS would independently predict arterial stiffness and endothelial dysfunction in CKD patients.RESEARCH DESIGN AND METHODSRisk factors for MS, carotid-femoral pulse wave velocity (CF-PWV) and flow-mediated dilation (FMD) as measures of arterial stiffness and endothelial dysfunction, respectively, were assessed in 113 minimally comorbid CKD patients and in 23 matched control subjects.RESULTSCF-PWV correlated with systolic blood pressure (SBP), waist circumference, and plasma glucose (r2 = 0.25, 0.09, and 0.09; P < 0.01 for all). FMD correlated with SBP (r2 = 0.09; P < 0.01) and waist circumference (r2 = 0.03; P < 0.05). CF-PWV increased progressively (r2 = 0.07; P < 0.01) with increasing number of risk factors for MS. In multiple linear regression, SBP and waist circumference were independent determinants of CF-PWV, whereas only SBP predicted FMD.CONCLUSIONSThe number of MS risk factors is an important determinant of arterial stiffness in CKD patients irrespective of the degree of renal impairment. Although BP remains the major determinant of arterial stiffness and endothelial dysfunction, waist circumference independently predicts arterial stiffness. MS risk factors, particularly abdominal girth, are potential targets for future interventional studies in patients with CKD.

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Section: Methodsmentioning

confidence: 99%

Risk Factors for Metabolic Syndrome Independently Predict Arterial Stiffness and Endothelial Dysfunction in Patients With Chronic Kidney Disease and Minimal Comorbidity

Lilitkarntakul

Dhaun²,

Melville³

et al. 2012

Diabetes Care

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“…This would significantly (1) increase glucose reabsorption at SGLT2 with decreased delivery of NaCl to macula densa and subsequent afferent arteriolar vasodilation and (2) RAAS activation and efferent arteriolar vasoconstriction reduce the time required for a standard iohexol GFR study from 4 to 5 h. Self-collection of DBS could be performed as an outpatient, since finger pricks are a common task for patients with type 1 diabetes, and the filter paper could then be mailed back to the lab [103,105]. The relative simplicity of the DBS method and better results compared to eGFR suggest that this or similar methodology may improve upon current practices used to assess GFR, which are either not feasible or effective in ascertaining early renal function loss clinically.…”

Section: Gfr Measured By Iohexol Clearance On Dried Blood Spotsmentioning

confidence: 99%

Update on Estimation of Kidney Function in Diabetic Kidney Disease

2015

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The American Diabetes Association recommends annual assessment of glomerular filtration rate (GFR) to screen for diabetic nephropathy. GFR is measured indirectly using markers that, ideally, are eliminated only by glomerular filtration. Measured GFR, although the gold standard, remains cumbersome and expensive. GFR is therefore routinely estimated using creatinine and/or cystatin C and clinical variables. In pediatrics, the Schwartz creatinine-based equation is most frequently used even though combined creatinine and cystatin C-based equations demonstrate stronger agreement with measured GFR. In adults, the CKD Epidemiology Collaboration (CKD-EPI) equations with creatinine and/or cystatin C are the most accurate and precise estimating equations. Despite recent advances, current estimates of GFR lack precision and accuracy before chronic kidney disease stage 3 (GFR < 60 mL/min/1.73 m(2)). There is therefore an urgent need to improve the methods for estimating and measuring GFR. In this review, we examine the current literature and data addressing measurement and estimation of GFR in diabetes.

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“…Finally, although it is recognised that these procedures will be beyond the resources of many centres, we also hope some research teams will be interested in performing measured GFRs using simplified iohexol clearance techniques in a subsample of the population in some centres [25]. These procedures will provide insight into the validity of GFR estimates across the range of kidney function using endogenous markers in the relevant populations.…”

Section: Introductionmentioning

confidence: 99%

International Collaboration for the Epidemiology of eGFR in Low and Middle Income Populations - Rationale and core protocol for the Disadvantaged Populations eGFR Epidemiology Study (DEGREE)

Caplin

Jakobsson

Glaser³

et al. 2017

BMC Nephrol

105

134

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BackgroundThere is an increasing recognition of epidemics of primarily tubular-interstitial chronic kidney disease (CKD) clustering in agricultural communities in low- and middle-income countries (LMICs). Although it is currently unclear whether there is a unified underlying aetiology, these conditions have been collectively termed CKD of undetermined cause (CKDu). CKDu is estimated to have led to the premature deaths of tens to hundreds of thousands of young men and women over the last 2 decades. Thus, there is an urgent need to understand the aetiology and pathophysiology of these condition (s). International comparisons have provided the first steps in understanding many chronic diseases, but such comparisons rely on the availability of standardised tools to estimate disease prevalence. This is a particular problem with CKD, since the disease is asymptomatic until the late stages, and the biases inherent in the methods used to estimate the glomerular filtration rate (GFR) in population studies are highly variable across populations.MethodWe therefore propose a simple standardised protocol to estimate the distribution of GFR in LMIC populations – The Disadvantaged Populations eGFR Epidemiology (DEGREE) Study. This involves the quantification of renal function in a representative adult population-based sample and a requirement for standardisation of serum creatinine measurements, along with storage of samples for future measurements of cystatin C and ascertainment of estimates of body composition, in order to obtain valid comparisons of estimated GFR (eGFR) within and between populations.DiscussionThe methodology we present is potentially applicable anywhere, but our particular focus is on disadvantaged populations in LMICs, since these appear to be most susceptible to CKDu. Although the protocol could also be used in specific groups (e.g. occupational groups, thought to be at excess risk of CKDu) the primary aim of the DEGREE project is characterise the population distribution of eGFR in multiple regions so that international comparisons can be performed. It is only with a standardised approach that it will be possible to estimate the scale of, and variation in, impaired kidney function between affected areas. These data should then provide insights into important social, demographic and environmental risk factors for this increasingly recognised disease.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-016-0417-1) contains supplementary material, which is available to authorized users.

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A Practical Method of Measuring Glomerular Filtration Rate by Iohexol Clearance Using Dried Capillary Blood Spots

Cited by 23 publications

References 35 publications

Risk Factors for Metabolic Syndrome Independently Predict Arterial Stiffness and Endothelial Dysfunction in Patients With Chronic Kidney Disease and Minimal Comorbidity

Risk Factors for Metabolic Syndrome Independently Predict Arterial Stiffness and Endothelial Dysfunction in Patients With Chronic Kidney Disease and Minimal Comorbidity

Update on Estimation of Kidney Function in Diabetic Kidney Disease

International Collaboration for the Epidemiology of eGFR in Low and Middle Income Populations - Rationale and core protocol for the Disadvantaged Populations eGFR Epidemiology Study (DEGREE)

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