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Luján P, Chiurchiu C, Capra R, de Arteaga J, de la Fuente J, Douthat W. Post-kidney donation glomerular filtration rate measurement and estimation. Nefrologia 2021; 41:191-199. [PMID: 36165380 DOI: 10.1016/j.nefroe.2020.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 07/10/2020] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Long-term consequences associated with kidney donation are controversial. Pre- and post-donation glomerular filtration rates (GFRs) are determinants of renal and cardiovascular risk weighting. In Latin America, there is limited experience in evaluating kidney function using GFR measurement techniques in kidney donors. The MDRD 4-variable and CKD-EPI equations are considered reasonable options. The objective of this study was to evaluate the performance of the MDRD and CKD-EPI equations in post-nephrectomy GFR dynamics in kidney donors. MATERIALS AND METHODS A prospective cohort study with GFR measurement and estimation in 189 kidney donors who underwent nephrectomy between 2007 and 2016 at the Hospital Privado Universitario de Córdoba [Private University Hospital of Córdoba] in Córdoba, Argentina. GFRs were evaluated before and after nephrectomy by iothalamate clearance determined by HPLC and by the MDRD and CKD-EPI equations for estimating GFR. Two groups were formed for this study: Group 1 (n=107), with an evaluation time subsequent to GFR stabilization (3 months) of up to 5 years, and Group 2 (n=82), with an evaluation time of 5-10 years following donation. Measured GFR (mGFR) was assessed by iothalamate clearance determined by HPLC. RESULTS Renal compensation values were 61.9% (52.0%-71.1%) and 75.6% (64.9%-84.4%) for Group 1 (n=107) and Group 2 (n=82), respectively. MDRD underestimated the GFR in 3.2% (90ml/min/1.73m2) and 38.6% (60ml/min/1.73m2) compared to the mGFR, and CKD-EPI underestimated the GFR in 2.6% (90ml/min/1.73m2) and 13.8% (60ml/min/1.73m2). Diagnostic performance was evaluated with a ROC curve (mGFR<60ml/min/1.73m2) for MDRD (ABC=0.66; CI: 0.59-0.73; sensitivity: 98.7%; specificity: 63.3%) and for CKD-EPI (ABC=0.79 CI: 0.73-0.85; sensitivity: 96.9%; specificity: 76.4%. Estimated GFR (eGFR) showed poor performance for estimating the glomerular filtration rate in the post-nephrectomy follow-up of donors over 50 years of age. CONCLUSIONS Equations for estimating GFRs showed poor performance for long-term follow-up of post-nephrectomy GFRs. Measuring GFRs to determine kidney function is recommended in the screening and follow-up of some donors under the current selection criteria.
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Affiliation(s)
- Pablo Luján
- Laboratorio de Bioquímica Clínica, Hospital Privado Universitario de Córdoba, Córdoba, Argentina.
| | - Carlos Chiurchiu
- Servicio de Nefrología, Hospital Privado Universitario de Córdoba y Carrera de posgrado de Nefrología, Universidad Católica de Córdoba, Córdoba, Argentina
| | - Raúl Capra
- Laboratorio de Bioquímica Clínica, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Javier de Arteaga
- Servicio de Nefrología, Hospital Privado Universitario de Córdoba y Carrera de posgrado de Nefrología, Universidad Católica de Córdoba, Córdoba, Argentina
| | - Jorge de la Fuente
- Servicio de Nefrología, Hospital Privado Universitario de Córdoba y Carrera de posgrado de Nefrología, Universidad Católica de Córdoba, Córdoba, Argentina
| | - Walter Douthat
- Servicio de Nefrología, Hospital Privado Universitario de Córdoba y Carrera de posgrado de Nefrología, Universidad Católica de Córdoba, Córdoba, Argentina
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Jarmi T, Khouzam S, Shekhar N, Hosni M, White L, Hodge DO, Mai ML, Wadei HM. The Impact of Different Induction Immunosuppressive Therapy on Long-Term Kidney Transplant Function When Measured by Iothalamate Clearance. J Clin Med Res 2021; 12:787-793. [PMID: 33447312 PMCID: PMC7781286 DOI: 10.14740/jocmr4369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 11/11/2020] [Indexed: 01/06/2023] Open
Abstract
Background Improvement in short-term outcomes after kidney transplant has been achieved by using different induction and maintenance therapeutic approaches. Long-term outcomes have not matched the expectations of the transplant stakeholders. Our study aimed to address the early impact of induction agents on long-term outcome of kidney transplant when measured by iothalamate clearance. Methods All adult kidney transplant recipients between January of 2012 and December of 2016 were reviewed. Six hundred forty-nine patients were divided into three groups based on the induction agent (basiliximab, alemtuzumab, and thymoglobulin). Protocoled 4 months and 48 months kidney allograft function evaluations with iothalamate clearance test were compared among the three groups. Results Patients who received basiliximab were significantly older with no difference among African American and Caucasians. The 48 months assessment showed significant decline in median iothalamate clearance in basiliximab group at 49 mL/min vs. alemtuzumab group 64.8 mL/min and thymoglobulin 60 mL/min with P = 0.007. The basiliximab group developed a significant higher proteinuria measured by spot urine to creatinine ratio at 48 months. Conclusions The use of basiliximab as an induction agent for kidney transplant is associated with significant decline in kidney function 4 years post transplantation when measured by iothalamate clearance.
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Affiliation(s)
- Tambi Jarmi
- Department of Transplant, Mayo Clinic Florida, Jacksonville, FL 32224, USA
| | - Samir Khouzam
- Department of Transplant, Mayo Clinic Florida, Jacksonville, FL 32224, USA
| | - Nitika Shekhar
- Department of Transplant, Mayo Clinic Florida, Jacksonville, FL 32224, USA
| | - Meray Hosni
- Department of Transplant, Mayo Clinic Florida, Jacksonville, FL 32224, USA
| | - Launia White
- Department of Health Sciences Research, Mayo Clinic Florida, Jacksonville, FL 32224, USA
| | - David O Hodge
- Department of Health Sciences Research, Mayo Clinic Florida, Jacksonville, FL 32224, USA
| | - Martin L Mai
- Department of Transplant, Mayo Clinic Florida, Jacksonville, FL 32224, USA
| | - Hani M Wadei
- Department of Transplant, Mayo Clinic Florida, Jacksonville, FL 32224, USA
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Luján P, Chiurchiu C, Capra R, de Arteaga J, de la Fuente J, Douthat W. Post-kidney donation glomerular filtration rate measurement and estimation. Nefrologia 2020; 41:191-199. [PMID: 33339672 DOI: 10.1016/j.nefro.2020.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 07/06/2020] [Accepted: 07/10/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Long-term consequences associated with kidney donation are controversial. Pre- and post-donation glomerular filtration rates (GFRs) are determinants of renal and cardiovascular risk weighting. In Latin America, there is limited experience in evaluating kidney function using GFR measurement techniques in kidney donors. The MDRD 4-variable and CKD-EPI equations are considered reasonable options. The objective of this study was to evaluate the performance of the MDRD and CKD-EPI equations in post-nephrectomy GFR dynamics in kidney donors. MATERIALS AND METHODS A prospective cohort study with GFR measurement and estimation in 189 kidney donors who underwent nephrectomy between 2007 and 2016 at the Hospital Privado Universitario de Córdoba [Private University Hospital of Córdoba] in Córdoba, Argentina. GFRs were evaluated before and after nephrectomy by iothalamate clearance determined by HPLC and by the MDRD and CKD-EPI equations for estimating GFR. Two groups were formed for this study: Group 1 (n=107), with an evaluation time subsequent to GFR stabilization (3 months) of up to 5 years, and Group 2 (n=82), with an evaluation time of 5-10 years following donation. Measured GFR (mGFR) was assessed by iothalamate clearance determined by HPLC. RESULTS Renal compensation values were 61.9% (52.0%-71.1%) and 75.6% (64.9%-84.4%) for Group 1 (n=107) and Group 2 (n=82), respectively. MDRD underestimated the GFR in 3.2% (90ml/min/1.73m2) and 38.6% (60ml/min/1.73m2) compared to the mGFR, and CKD-EPI underestimated the GFR in 2.6% (90ml/min/1.73 m2) and 13.8% (60ml/min/1.73 m2). Diagnostic performance was evaluated with a ROC curve (mGFR<60ml/min/1.73 m2) for MDRD (ABC=0.66; CI: 0.59-0.73; sensitivity: 98.7%; specificity: 63.3%) and for CKD-EPI (ABC=0.79 CI: 0.73-0.85; sensitivity: 96.9%; specificity: 76.4%. Estimated GFR (eGFR) showed poor performance for estimating the glomerular filtration rate in the post-nephrectomy follow-up of donors over 50 years of age. CONCLUSIONS Equations for estimating GFRs showed poor performance for long-term follow-up of post-nephrectomy GFRs. Measuring GFRs to determine kidney function is recommended in the screening and follow-up of some donors under the current selection criteria.
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Affiliation(s)
- Pablo Luján
- Laboratorio de Bioquímica Clínica, Hospital Privado Universitario de Córdoba, Córdoba, Argentina.
| | - Carlos Chiurchiu
- Servicio de Nefrología, Hospital Privado Universitario de Córdoba y Carrera de posgrado de Nefrología, Universidad Católica de Córdoba, Córdoba, Argentina
| | - Raúl Capra
- Laboratorio de Bioquímica Clínica, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Javier de Arteaga
- Servicio de Nefrología, Hospital Privado Universitario de Córdoba y Carrera de posgrado de Nefrología, Universidad Católica de Córdoba, Córdoba, Argentina
| | - Jorge de la Fuente
- Servicio de Nefrología, Hospital Privado Universitario de Córdoba y Carrera de posgrado de Nefrología, Universidad Católica de Córdoba, Córdoba, Argentina
| | - Walter Douthat
- Servicio de Nefrología, Hospital Privado Universitario de Córdoba y Carrera de posgrado de Nefrología, Universidad Católica de Córdoba, Córdoba, Argentina
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Seegmiller JC, Eckfeldt JH, Lieske JC. Challenges in Measuring Glomerular Filtration Rate: A Clinical Laboratory Perspective. Adv Chronic Kidney Dis 2018; 25:84-92. [PMID: 29499892 DOI: 10.1053/j.ackd.2017.10.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 10/12/2017] [Accepted: 10/16/2017] [Indexed: 11/11/2022]
Abstract
The assessment of kidney function is a cornerstone in the clinical management and health of the patient. Although the kidneys perform many physiologic functions and are essential for maintaining homeostasis, kidney function is typically evaluated, quantitated, and understood using the glomerular filtration rate (GFR). Although GFR can be directly measured using a variety of externally administered glomerular filtration markers, in general practice, the GFR is usually estimated (eGFR) using endogenous markers that are cleared primarily by kidney filtration. Common situations exist where the GFR needs to be measured (mGFR) in order to proceed with care. This manuscript will review laboratory challenges in the assessment of GFR. Key points to consider when implementing a mGFR testing protocol are the following: marker selection, clearance methodology (urinary vs solely plasma measurements of filtration marker), sample collection, number of samples to collect, staff required, and analytical measurement technology for the filtration marker selected. We suggest those wanting to implement mGFR testing examine site-specific institutional resources along with patient population and proceed with the approaches best suited for their clinical needs and laboratory resources available.
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Bjornstad P, Karger AB, Maahs DM. Measured GFR in Routine Clinical Practice-The Promise of Dried Blood Spots. Adv Chronic Kidney Dis 2018; 25:76-83. [PMID: 29499891 DOI: 10.1053/j.ackd.2017.09.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 09/17/2017] [Accepted: 09/20/2017] [Indexed: 12/31/2022]
Abstract
Accurate determination of glomerular filtration rate (GFR) is crucial for the diagnosis of kidney disease. Estimated GFR (eGFR) calculated by serum creatinine and/or cystatin C is a mainstay in clinical practice and epidemiologic research but lacks precision and accuracy until GFR <60 mL/min/1.73 m2. Furthermore, eGFR may not precisely and accurately represent changes in GFR longitudinally. The lack of precision and accuracy is of concern in populations at high risk for kidney disease, as the dissociation between changes in eGFR and GFR may lead to missed diagnoses of early kidney disease. Therefore, improved methods to quantify GFR are needed. Whereas direct measures of GFR have been too cumbersome for screening and ambulatory care, a practical method of measuring GFR by iohexol clearance using dried capillary blood spots exists. In this review, we examine the current literature and data addressing GFR measurements by dried capillary blood spots and its potential application in high-risk groups.
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Shah I, Barker J, Naughton DP, Barton SJ, Ashraf SS. HPLC estimation of iothalamate to measure glomerular filtration rate in humans. Chem Cent J 2016; 10:80. [PMID: 28028385 PMCID: PMC5151096 DOI: 10.1186/s13065-016-0227-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 12/01/2016] [Indexed: 11/10/2022] Open
Abstract
Glomerular filtration rate (GFR) is usually determined by estimation of iothalamate (IOT) clearance. We have developed and validated an accurate and robust method for the analysis of IOT in human plasma and urine. The mobile phase consisted of methanol and 50 mM sodium phosphate (10:90; v/v). Flow rate was 1.2 mL/min on a C18 reverse phase column, Synergi-hydro (250 × 4.6 mm) 4 µm 80 Å, with an ultraviolet detector set to 254 nm. Acetonitrile was used for the deproteination and extraction of IOT from human plasma and urine. Precision and accuracy were within 15% for IOT in both plasma and urine. The recoveries of IOT in urine and plasma ranged between 93.14% and 114.74 and 96.04-118.38%, respectively. The linear range for urine and plasma assays were 25-1500 and 1-150 µg/mL respectively. The lower limits of detection were 0.5 µg/mL for both urine and plasma, with no interference from plasma and urine matices. This method has been fully validated according to FDA guidelines and the new HPLC assay has been applied to a new formulation of IOT (Conray™ 43), to calculate GFR in healthy volunteers. The new method is simple, less expensive and it would be instrumental in future clinical and pharmacokinetic studies of iothalamate in kidney patients.
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Affiliation(s)
- Iltaf Shah
- Department of Chemistry, College of Science, United Arab Emirates University, Al Ain, UAE
| | - James Barker
- School of Life Sciences, Pharmacy and Chemistry, Kingston University, Penrhyn Road, Kingston-upon-Thames, Surrey, KT1 2EE UK
| | - Declan P Naughton
- School of Life Sciences, Pharmacy and Chemistry, Kingston University, Penrhyn Road, Kingston-upon-Thames, Surrey, KT1 2EE UK
| | - Stephen J Barton
- School of Life Sciences, Pharmacy and Chemistry, Kingston University, Penrhyn Road, Kingston-upon-Thames, Surrey, KT1 2EE UK
| | - Syed Salman Ashraf
- Department of Chemistry, College of Science, United Arab Emirates University, Al Ain, UAE
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