Assessment of Glomerular Filtration Rate Measurement with Plasma Sampling: A Technical Review

Murray, Anthony W.; Barnfield, Mark C.; Waller, Michael L.; Telford, Tania; Peters, A. M.

doi:10.2967/jnmt.113.121004

Cited by 49 publications

(59 citation statements)

References 29 publications

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“…The plasma 99m Tc-DTPA method used 2 plasma samples obtained at 1 and 3 h after the intravenous administration of 99m Tc-DTPA (16,17). Each sample was ultrafiltered to remove plasma proteins by a described method (21).…”

Section: Measured (Reference) Gfr Methodsmentioning

confidence: 99%

“…Camera-based methods are hampered by attenuation factors, leading to a general preference for plasma clearance methods. Methods for measuring GFR have been developed using a single intravenous injection of 99m Tc-DTPA, followed either by single or by multiple plasma samples (16,17). The single-injection, 1-compartment, 2-sample slope-intercept clearance method is widely used.…”

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confidence: 99%

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Comparison of Performance of Improved Serum Estimators of Glomerular Filtration Rate (GFR) to ^99mTc-DTPA GFR Methods in Patients with Hepatic Cirrhosis

Haddadin

Lee

Conlin

et al. 2017

J. Nucl. Med. Technol.

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Glomerular filtration rate (GFR) measurements are critical in patients with hepatic cirrhosis but potentially erroneous when based on serum creatinine. New equations for estimated GFR (eGFR) have shown variable performance in cirrhotics, possibly because of inaccuracies in reference methods for measured GFR (mGFR). The primary objective was to compare the performance of 4 improved eGFR equations with a 1-compartment, 2-sample plasma slope intercept 99m Tc-DTPA mGFR method to determine whether any of the eGFR calculations could replace plasma 99m Tc-DTPA mGFR in patients with cirrhosis. The secondary objective was to test the hypothesis that mGFR using voluntary voided urine collections introduces error compared with plasmaonly methods. Methods: Fifty-four patients with hepatic cirrhosis underwent mGFR determinations from 2 plasma samples at 1 and 3 h after intravenous administration of 185 MBq of 99m Tc-DTPA. GFR was also generated by a UV/P calculation derived from blood and urine samples. These mGFRs were compared with the eGFRs generated by 4 estimating equations: MDRD (Modified Diet in Renal Disease), CKD-EPI (Chronic Kidney Disease-Epidemiology Collaboration) (serum creatinine [SCr]), CKD-EPI (cystatin [CysC]), and CKD-EPI (CysC1SCr). eGFRs were compared with mGFRs by Pearson correlation, precision, bias, percentage bias, and accuracy (eGFRs varying by ,10% [p10], ,20% [p20] or ,30% [p30] from the corresponding mGFR). Results: All eGFRs showed poorer performance when the UV/P 99m Tc-DTPA mGFR was used as the reference than when the plasma 99m Tc-DTPA mGFR was used. When compared with the plasma 99m Tc-DTPA mGFR method, the performance of all eGFR equations was superior to most published reports. There was a moderately good positive correlation between eGFRs and mGFRs. When compared with plasma 99m Tc-DTPA mGFR, precision of eGFRs was in the range of 14-20 mL/min and showed a negligible bias. Compared with the plasma 99m Tc-DTPA mGFR, CKD-EPI (CysC1SCr) showed the best overall performance and accuracy, at 85.19% (p30), 75.93% (p20), and 42.59% (p10). Conclusion: Estimating equations for measuring eGFR performed better than in most published reports, attributable to use of the plasma 99m Tc-DTPA mGFR method as a reference. CKD-EPI (CysC1SCr) eGFR showed the best overall performance. However, more discriminating methods may be required when accurate GFR measurements are necessary. mGFR measurements using urine collections may introduce error compared with plasma-only methods.

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Section: Measured (Reference) Gfr Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

Comparison of Performance of Improved Serum Estimators of Glomerular Filtration Rate (GFR) to ^99mTc-DTPA GFR Methods in Patients with Hepatic Cirrhosis

Haddadin

Lee

Conlin

et al. 2017

J. Nucl. Med. Technol.

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“…A technical review of GFR studies can be found elsewhere [5]. This technique is commonly used in the evaluation and monitoring of renal function in cases of chronic kidney disease, throughout courses of nephrotoxic drugs [6,7], and for the evaluation of renal function in potential live donors, among other applications [2].…”

Section: Introductionmentioning

confidence: 99%

“…The routine method of GFR measurement with a radionuclide involves measuring the area under the plasma clearance curve (AUC) [2,5]. GFR can be calculated by dividing the administered dose by the AUC.…”

Section: Introductionmentioning

confidence: 99%

“…The AUC is characterized by the count rates from plasma samples obtained after administration of the tracer. The clearance curve is composed of two main exponential phases, early and late, but the late exponential dominates after ∼ 2 h [2,5]. Full characterization of the clearance curve provides the most accurate and direct method of quantifying renal function [2,5,8,9].…”

Section: Introductionmentioning

confidence: 99%

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UK audit of glomerular filtration rate measurement from plasma sampling in 2013

Murray

Lawson

Cade

et al. 2014

Nuclear Medicine Communications

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Fundamental problems with pediatric adaptive dosing of carboplatin using nuclear‐medicine‐based estimates of renal function

Adamson

Veal

Womer

et al. 2019

Pediatric Blood & Cancer

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Background Carboplatin is often adaptively dosed based on glomerular filtration rate (GFR), usually estimated by nuclear medicine tests. At least five pediatric adaptive dosing formulas have been developed. In an effort to standardize dosing in Children's Oncology Group protocols, we explored methodologic variation in GFR estimation and adaptive‐dosing formula performance. Procedure Nuclear medicine GFR data from published series of ≥100 children with cancer were compared. Data from patients for whom body surface area, weight, GFR, and tracer half‐life were available were used to compare formulas. Results Differences in methods used to estimate GFR in children with cancer resulted in highly variable population results, with median GFRs ranging from 96 to 150 mL/min/1.73m2. The choice of adaptive formula had a major impact on calculated dose. When targeting an area under the curve of 7.9 mg/mL • min, the median difference between the formula yielding the lowest and highest carboplatin dose for individual subjects was 289 (range 96‐1 737) mg/m2. Conclusions Wide variation in GFR obtained with nuclear‐medicine‐based tests in children with cancer primarily results from systematic methodologic errors. Formulas for calculating carboplatin dose produce additional and substantial variation that may place children with cancer at unnecessary risk for excessive toxicity or underdosing. These findings indicate a need for the development of a uniform, validated method for GFR determination in children that should be utilized in all centers. Currently, adaptive dosing of carboplatin based on GFR has serious limitations and in most clinical settings should arguably not be used in place of body‐surface‐area‐based dosing.

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Assessment of Glomerular Filtration Rate Measurement with Plasma Sampling: A Technical Review

Cited by 49 publications

References 29 publications

Comparison of Performance of Improved Serum Estimators of Glomerular Filtration Rate (GFR) to ^99mTc-DTPA GFR Methods in Patients with Hepatic Cirrhosis

Comparison of Performance of Improved Serum Estimators of Glomerular Filtration Rate (GFR) to ^99mTc-DTPA GFR Methods in Patients with Hepatic Cirrhosis

UK audit of glomerular filtration rate measurement from plasma sampling in 2013

Fundamental problems with pediatric adaptive dosing of carboplatin using nuclear‐medicine‐based estimates of renal function

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Assessment of Glomerular Filtration Rate Measurement with Plasma Sampling: A Technical Review

Cited by 49 publications

References 29 publications

Comparison of Performance of Improved Serum Estimators of Glomerular Filtration Rate (GFR) to 99mTc-DTPA GFR Methods in Patients with Hepatic Cirrhosis

Comparison of Performance of Improved Serum Estimators of Glomerular Filtration Rate (GFR) to 99mTc-DTPA GFR Methods in Patients with Hepatic Cirrhosis

UK audit of glomerular filtration rate measurement from plasma sampling in 2013

Fundamental problems with pediatric adaptive dosing of carboplatin using nuclear‐medicine‐based estimates of renal function

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Comparison of Performance of Improved Serum Estimators of Glomerular Filtration Rate (GFR) to ^99mTc-DTPA GFR Methods in Patients with Hepatic Cirrhosis

Comparison of Performance of Improved Serum Estimators of Glomerular Filtration Rate (GFR) to ^99mTc-DTPA GFR Methods in Patients with Hepatic Cirrhosis