Optimal Sampling Strategies to Assess Inulin Clearance in Children by the Inulin Single-Injection Method

Rossum, L. K. van; Mathôt, Ron A. A.; Cransberg, Karlien; Vulto, Arnold G.

doi:10.1373/49.7.1170

Cited by 25 publications

(17 citation statements)

References 22 publications

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“…This large value led us to question the precision of the gold standard in their study; it was the only study that used one shot of inulin rather than a constant perfusion as a gold standard. The one-shot inulin method has been validated in children [43], but not in elderly patients. A previous paper by the same authors also reported a similarly large SD of ME [42].…”

Section: Resultsmentioning

confidence: 99%

Should We Continue to Use the Cockcroft-Gault Formula?

Hélou¹

2010

Nephron Clin Pract

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Background/Aims: Although the National Kidney Disease Education Program recommends use of the modification of diet in renal disease (MDRD) formula to estimate the glomerular filtration rate (GFR), most drug-dosing recommendations and clinical practices employ the Cockcroft-Gault (CG) formula. The quality score of the original MDRD study was better than that of the original CG study, although the imprecision sources were very similar between the formulas. To address whether CG should be abandoned in favour of MDRD in chronic kidney disease (CKD) management, we performed a literature review on the topic. Methods: We reviewed 27 articles comparing CG and MDRD in terms of bias, precision, accuracy, and the risk of misclassifying by two CKD stages. Results: In the chronic renal disease population, MDRD was more precise, safer and more accurate than CG at predicting the GFR, with two exceptions: CG was clearly superior in CKD patients with a normal serum creatinine (SCr) and results were discordant in patients with advanced renal failure. In diabetic populations with normal and near-normal GFR, the decline in renal function in diabetics was better screened by CG. In diabetics with renal impairment, MDRD is more accurate than CG. In healthy patients, in subjects with normal SCr and in elderly patients, MDRD was not superior. Based on the risk of misclassifying by ≧2 CKD stages, neither formula could be safely applied in diabetic, low body mass index, advanced liver disease, chronic heart failure, or hospitalized patients. Conclusions: CG still has an interest in screening the decline in renal function in subjects with normal SCr who are at risk, such as diabetics and stage 1 and 2 CKD patients, as well as healthy subjects enrolled in clinical trials and pharmacokinetic studies. Thus, it may be early to replace CG by MDRD in drug studies. CG still is the better formula in the elderly. Both formulas are not safe in some populations.

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Section: Resultsmentioning

confidence: 99%

Should We Continue to Use the Cockcroft-Gault Formula?

Hélou¹

2010

Nephron Clin Pract

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“…The Zappitelli equations were calibrated using a constant-infusion iothalamate clearance (20), whereas the updated equations by Schwartz used a singleinjection iohexol clearance (11,23). We have used the inulin single-injection method, which has been shown to be accurate for determining true GFR in children and adults (8,42). Inulin was measured by an enzymatic method, which has a lower sensitivity than mass spectrometry measurement and could be biased by cross-reactions with other serum metabolites, such as glucose.…”

Section: Discussionmentioning

confidence: 99%

“…GFR was measured by the inulin single-injection method, which has been proven to be an accurate method to determine true GFR (GFR-inulin) in children (8). All patients received a single intravenous dose (5000 mg/ 1.73 m 2 of body surface area with a maximum dose of 5000 mg) of inulin (Inutest, Fresenius, Bad Homburg, Germany), which was administered within 1 minute.…”

Section: Measurementsmentioning

confidence: 99%

“…Inulin was measured within 14 days using an enzymatic method based on the determination of fructose after acid hydrolysis of inulin as described by Jung et al (28), with some minor modifications (29). GFR-inulin (ml/min per 1.73 m 2 ) was calculated according to a two-compartmental model with MW/Pharm 3.5 software (Mediware, Groningen, The Netherlands), a pharmacokinetic program using a Bayesian estimate from patient and population data (8).…”

Section: Measurementsmentioning

confidence: 99%

“…Unfortunately, a gold standard measurement of GFR by inulin clearance is cumbersome, costly, and therefore not commonly available (8). In daily pediatric care, equations that use creatinine to obtain an estimated GFR (eGFR) have been widely adopted by clinicians, as recommended in the Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines (9).…”

Section: Introductionmentioning

confidence: 99%

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Precision of Estimating Equations for GFR in Children with a Solitary Functioning Kidney

Westland

Abraham

Bökenkamp

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objective Children with a solitary functioning kidney may develop CKD. Although widely used, equations to estimate GFR are not validated in these patients. This study sought to determine the precision of common estimating equations in the KIMONO (KIdney of MONofunctional Origin) cohort. Results The eGFR-CKiD2 equation performed best in children with a solitary functioning kidney (mean bias, 20.9 ml/min per 1.73 m 2 ; 95% and 54% of values within 630% and 610% of GFR-inulin, respectively). Mean bias for eGFR-Schwartz was 0.4 ml/min per 1.73 m 2 , with 90% and 33% of values within 630% and 610% of GFR-inulin, respectively. For all estimates, misclassification in K/DOQI stage ranged from 22% (eGFR-Zappitelli1) to 44% (urinary creatinine clearance) of children.Conclusions Use of a combined serum cystatin C/creatinine-based equation (eGFR-CKiD2) is recommended to monitor renal function in children with a solitary functioning kidney. When cystatin C is not routinely available, eGFR-Schwartz should be used. Misclassification in K/DOQI-stage remains a caveat for all equations.

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Bepaling van de glomerulaire filtratiesnelheid bij kinderen door middel van de inuline single injectiemethode

Rossum¹,

Cransberg²,

Mathôt³

et al. 2005

KIND

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Summary Background. Renal function can be assessed by determination of the glomerular filtration rate (GFR). The standard method to determine GFR in children is the urinary clearance of inulin during a continuous intravenous infusion. However, this method is complex and invasive. Alternatively, the plasma clearance of inulin can be determined by single injection of inulin. The aim of this study was to validate the single injection method with a limited number of blood samples in pediatric patients.Method. Determination of the inulin plasma clearance by single injection was performed in 48 patients. A single injection of inulin (5000 mg/m 2 ) was administered and blood samples were withdrawn at 0, 10, 20, 30, 45, 60, 90, 120, 150, 180 and 240 minutes after administration. The inulin plasma clearance based on four blood samples (10, 30, 90 and 240 minutes) was compared with the inulin plasma clearance based on all blood samples (reference clearance).Results. In patients with GFR<75 ml/min/1.73 m 2 the mean difference between the inulin plasma clearance based on four blood samples and the reference clearance was not statistically significant. For GFR>75 ml/min/1.73 m 2 a small bias was observed (mean difference: -5.92 ml/ min/1.73 m 2 ; 95% confidence interval: -10.2 to -1.68 ml/ min/1.73 m 2 ). Conclusion. In patients with decreased renal function the inulin plasma clearance determined by the single injection method with four blood samples agreed well with the inulin plasma clearance based on eleven blood samples. As a consequence, it is a simple and convenient method to determine the renal function in pediatric patients.Samenvatting Achtergrond. De glomerulaire filtratiesnelheid (GFR) is een maat voor de nierfunctie. De gouden standaard voor het bepalen van de GFR bij kinderen bestaat uit het toedienen van inuline via continue infusie en het verzamelen van urinemonsters. Een nadeel is dat deze methode complex en patie¨ntonvriendelijk is. Als alternatief kan de plasmaklaring van inuline worden bepaald met een eenmalige injectie van inuline. Het doel van dit onderzoek is de inuline single injectiemethode met een beperkt aantal bloedmonsters bij kinderen te valideren.Methode. De plasmaklaring van inuline werd bij 48 kinderen met behulp van de inuline single injectiemethode bepaald. Hiervoor werd inuline als eenmalige injectie gegeven in een dosis van 5000 mg/m 2 . Vervolgens werden bloedmonsters afgenomen op 0, 10, 20, 30, 45, 60, 90, 120, 150, 180 en 240 minuten na toediening. De plasmaklaring van inuline berekend op basis van vier afnametijdstippen (10, 30, 90 en 240 minuten) werd vergeleken met de klaring berekend aan de hand van alle afnametijdstippen (referentieklaring).Resultaten. Bij een GFR<75 ml/min/1,73 m 2 werd geen significant verschil tussen de plasmaklaring van inuline met vier afnametijdstippen en de referentieklaring gevonden. Bij een GFR>75 ml/min/1,73 m 2 was er sprake van een lichte bias (gemiddeld verschil in inulineklaring: -5,92 ml/min/1,73 m 2 ; 95%-betrouwbaarheidsinterval -10,2 tot -1,68 ...

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Optimal Sampling Strategies to Assess Inulin Clearance in Children by the Inulin Single-Injection Method

Cited by 25 publications

References 22 publications

Should We Continue to Use the Cockcroft-Gault Formula?

Should We Continue to Use the Cockcroft-Gault Formula?

Precision of Estimating Equations for GFR in Children with a Solitary Functioning Kidney

Bepaling van de glomerulaire filtratiesnelheid bij kinderen door middel van de inuline single injectiemethode

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