Estimated glomerular filtration rate by formulas in patients with cirrhosis: An unreliable procedure

Abstract

Background & Aims: In cirrhosis, the reliability of formulas that estimate renal function, either those specifically developed in this population or the classic equations, has not been properly quantified. We studied the agreement between estimated (eGFR) and measured glomerular filtration rate (mGFR) in cirrhosis. Methods: Renal function was estimated with 56 formulas including specific equations:Glomerular Filtration Rate Assessment in Liver Disease (GRAIL), Royal Free Hospital Cirrhosis (RFHC) and Mindikoglu-eGFR, and measured with a gold standard procedure; plasma clearance of iohexol using dried blood spots sampling in a group of cirrhotics. The agreement eGFR-mGFR was evaluated with specific tests: total deviation index (TDI), concordance correlation coefficient (CCC) and coverage probability (CP).We defined acceptable agreement as values: TDI < 10%, CCC ≥ 0.9 and CP > 90%.Results: A total of 146 patients (age 65 ± 9 years, 81% male) were evaluated; 61 (42%) Child A, 67 (46%) Child B and 18 (12%) Child C. Median MELD-Na was 14 (9-15). The agreement between eGFR and mGFR was poor: TDI averaged was of 73% (90% of the estimations ranged from ±73% of mGFR); CCC averaged was 0.7 indicating low concordance and CP averaged 22% indicating that 78% of the estimations have an

A Systematic Literature Review on the Use of Dried Biofluid Microsampling in Patients With Kidney Disease

“…All employed DBS to calculate the GFR at defined time points using contrast agents, iohexol ( n = 7) or iothalamate ( n = 1). All studies demonstrated positive findings in support of DBS sampling [ 20 , 21 , 22 , 23 , 24 , 55 , 56 , 57 ]. It was however reported in one study that patients with a low haematocrit had errors in GFR measurement when using DBS; however, the authors overcame this with the use of a dried plasma sample [ 21 ].…”

“…The reduced cost of dried biofluid microsampling is a frequently cited advantage of microsampling. A total of 10 studies (14.9%) stated that dried biofluid microsampling was cheaper relative to traditional venous blood collection [ 24 , 26 , 29 , 32 , 38 , 43 , 56 , 66 , 72 ]. This was due to reduced costs associated with sample preparation, consumables and storage at room temperature [ 24 , 32 , 56 , 72 ].…”

“…A total of 10 studies (14.9%) stated that dried biofluid microsampling was cheaper relative to traditional venous blood collection [ 24 , 26 , 29 , 32 , 38 , 43 , 56 , 66 , 72 ]. This was due to reduced costs associated with sample preparation, consumables and storage at room temperature [ 24 , 32 , 56 , 72 ]. Furthermore, there were significant staff savings [ 32 , 45 ].…”

Iohexol plasma and urinary concentrations in cirrhotic patients: A pilot study

“…Iohexol has the advantages of being nontoxic (at the dose used to estimate the GFR), filtered by the glomerulus, and not reabsorbed or secreted by the tubules; it is also inexpensive compared to inulin and Cr-EDTA. However, only a few studies have assessed iohexol in compensated and noncirrhotic populations[ 7 - 9 ]. Moreover, those studies had several limitations, such as use of plasma samples only, or insufficient samples or a small collection time window.…”