Glomerular Filtration Rate (GFR) determination via individual kinetics of the inulin-like polyfructosan sinistrin versus creatinine-based population-derived regression formulae

BMC Nephrology

Alexander R Rosenkranz³  Willibald Estelberger²  Doris Wagner¹  Andreas Meinitzer⁴  Gilbert Reibnegger²  Walter Schrabmair²  Sabine Zitta³ 

[1] Department of Surgery, Division of Transplantation, Medical University Graz, Graz, Austria;Institute of Physiological Chemistry, Center for Physiological Medicine, Medical University Graz, Graz, Austria;Department of Internal Medicine, Clinical Division of Nephrology, Medical University Graz, Graz, Austria;Department of Laboratory Medicine, Medical University Graz, Graz, Austria

关键词: Kinetics;    Sinistrin;    mGFR;    CKD-EPI;    MDRD;    eGFR;   

Others  :  1082880
DOI  :  10.1186/1471-2369-14-159

 received in 2012-10-24, accepted in 2013-07-18,  发布年份 2013

【 摘 要 】

Background

In renal patients estimation of GFR is routinely done by means of population-based formulae using serum creatinine levels. For GFR determination in the creatinine-blind regions or in cases of reno-hepatic syndrome as well as in critical cases of live kidney donors individualized measurements of GFR (mGFR) employing the kinetics of exogenous filtration markers such as the inulin-like polyfructosan sinistrin are necessary. The goal of this study is to compare mGFR values with the eGFR values gained by the Modification of Diet in Renal Disease (MDRD4) and Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) formulae.

Methods

In 170 subjects comprising persons with normal renal function or with various stages of kidney diseases (CKD 1-4) GFR was measured by application of intravenous bolus of sinistrin and assessment of temporal plasma concentration profiles by means of pharmacokinetic methods (mGFR). Comparisons of mGFR with MDRD4- and CKD-EPI-derived eGFR values were performed by means of linear regression and Bland-Altman analyses.

Results

Reasonable agreement of mGFR and eGFR values was observed in patients with poor renal function [GFR below 60 (ml/min)/1.73 m²]. In cases of normal or mildly impaired renal function, GFR determination by MDRD4 or CKD-EPI tends to underestimate GFR. Notably, there is practically no difference between the two eGFR methods.

Conclusions

For routine purposes or for epidemiological studies in cases of poor renal function eGFR methods are generally reliable. But in creatinine-blind ranges [GFR above 60 (ml/min)/1.73 m²] eGFR values are unreliable and should be replaced by clinically and physiologically suitable methods for mGFR determination.

Consort

http://www.consort-statement.org/index.aspx?o=1190 webcite

【 授权许可】

   
2013 Zitta et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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