Comparison of Simultaneous Renal Clearances of True Endogenous Creatinine and Subcutaneously Administered lothalamate in Man

Pollock, Carol; Györy, Á. Z.; Hawkins, Therese; Ross, M.; Ibels, L. S.

doi:10.1159/000168849

Cited by 7 publications

(5 citation statements)

References 13 publications

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“…However, data from several studies demonstrated good agreement between creatinine clearance and 'true filtration markers'. These studies reported a close correlation between creatinine clearance and inulin [20], creatinine clearance and 125 I-iothalamate [21][22][23], and creatinine clearance and 99m Tc-DTPa [24,25] at all levels of renal function. Furthermore a metaanalysis found that creatinine clearance accurately detected even moderate GFR reduction and reflected changes in GFR well [26].…”

Section: Discussionmentioning

confidence: 99%

Cystatin C: Efficacy as Screening Test for Reduced Glomerular Filtration Rate

et al. 2000

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Serum cystatin C, a cysteine proteinase inhibitor, has been proposed as a marker of glomerular filtration rate (GFR). Serum cystatin C, serum creatinine and creatinine clearance were measured in 226 patients with various nephropathies, covering the entire range of renal function, to evaluate the efficacy of cystatin C as a screening test to detect reduced creatinine clearance in comparison to creatinine. Subgroups of 53 patients with glomerular and 26 patients with tubular impairment were compared to assess whether cystatin C performed differently in either glomerular or tubular impairment. Cystatin C detected reduced creatinine clearance with higher sensitivity (97 vs. 83%), and higher negative predictive value (96 vs. 87%) compared to creatinine. In parallel, 95% sensitivity of cystatin C as derived from receiver-operating characteristic plot was significantly higher (p < 0.05). In the subgroups with glomerular or tubular impairment, cystatin C and creatinine did not significantly differ with regard to efficacy. Serum cystatin C is as efficacious as serum creatinine to detect reduced GFR as measured by creatinine clearance. The efficacy of cystatin C as a screening test may even be superior compared to creatinine. In addition, the efficacy of cystatin C is independent of either glomerular or tubular impairment.

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Section: Discussionmentioning

confidence: 99%

Cystatin C: Efficacy as Screening Test for Reduced Glomerular Filtration Rate

et al. 2000

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“…Using creatinine clearance as reference method to assess the performance of serum cystatin C and serum creatinine, we are aware that creatinine clearance can result in an inaccurate estimate of GFR [2,22,261. However, good agreement between creatinine clearance and "true" markers of GFR as inulin [3], 1251-iothalamate [16] and 99mTc-DTPA clearance [17,20] at all levels of renal function was reported. Therefore, we used creatinine clearance as a reasonably accurate estimate of GFR, although we recognize that creatinine clearance has limitations and does not exactly measure GFR.…”

Section: Discussionmentioning

confidence: 99%

Cystatin C - an accurate marker of glomerular filtration rate after renal transplantation?

et al. 2000

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The performance of serum cystatin C as a screening marker of reduced creatinine clearance in renal transplantation was evaluated and compared to serum creatinine. In addition we studied whether cystatin C accurately reflects creatinine clearance over the entire range of transplant function. Serum cystatin C, serum creatinine, and creatinine clearance were measured in 110 adult renal transplant recipients. Cystatin C detected reduced creatinine clearance with the high sensitivity of 95 YO. Serum cystatin C and serum creatinine did not differ regarding 90 and 95 YO sensitivity, derived from the receiver-operating characteristics plot. We demonstrated a strong correlation and linear association between l/cystatin C and creatinine clearance over the entire range of transplant function,

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“…Commonly, creatinine clearance is used, even though it is well known that creatinine clearance usually exceeds GFR. The relationship between these two measures in patients with GFR values Յ10 ml/min, according to 13 published reports (33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46), is depicted in Figure 2, including two studies (38,45) in patients on dialysis (many other publications do not report their data in sufficient detail to permit even approximate conversion of their graphical observations to numerical estimates). The ratio of creatinine clearance to simultaneously measured GFR in these 115 observations varies considerably; the mean is 1.34 Ϯ 0.43 (SD).…”

Section: Discussionmentioning

confidence: 99%

“…The ratio of creatinine clearance to measured GFR in severe renal failure (GFR Ͻ10 ml/min), according to 115 observations, approximately graphed from 13 published studies (32-45), including two (37,44) in patients on dialysis. Wide variation in the ratio is seen.…”

Section: Figurementioning

confidence: 99%

Can Renal Replacement Be Deferred by a Supplemented Very Low Protein Diet?

Walser

Hill

1999

Journal of the American Society of Nephrology

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Abstract. Patients with chronic renal failure are commonly started on renal replacement therapy (RRT) as soon as (or, in some centers, before) the usual criteria for severity are met, i.e., GFR <10 ml/min for nondiabetic patients and <15 ml/min for diabetic patients. To determine whether RRT can safely be deferred beyond this point, adults with all types of chronic renal failure who met these criteria on presentation (23 patients) or who reached these levels of severity during treatment (53 patients) were managed conservatively until RRT was judged necessary by their chosen dialysis or transplantation team, without input into this decision from the present authors. Patients were prescribed a very low protein diet (0.3 g/kg) plus supplemental essential amino acids and/or ketoacids and followed closely. The intervals between the time at which GFR became less than 10 ml/min (15 ml/min in diabetic patients) and the date at which renal replacement therapy was started were used as estimates of renal survival on nutritional therapy. Kaplan—Meier analysis showed median renal survival of 353 d. Acidosis and hypercholesterolemia were both predictive of shorter renal survival. Signs of malnutrition did not develop. Final GFR averaged 5.6 ± 1.9 ml/min. Two patients died; thus, annual mortality was only 2.5%. Hospitalizations totaled 19 in 93 patient-years of treatment, or 0.2 per year. Thus, these well motivated patients with GFR <10 ml/min (<15 ml/min in diabetic patients) were safely managed by diet and close follow-up for a median of nearly 1 yr without dialysis. It is concluded that further study of this approach is indicated.

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Comparison of Simultaneous Renal Clearances of True Endogenous Creatinine and Subcutaneously Administered lothalamate in Man

Cited by 7 publications

References 13 publications

Cystatin C: Efficacy as Screening Test for Reduced Glomerular Filtration Rate

Cystatin C: Efficacy as Screening Test for Reduced Glomerular Filtration Rate

Cystatin C - an accurate marker of glomerular filtration rate after renal transplantation?

Can Renal Replacement Be Deferred by a Supplemented Very Low Protein Diet?

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