TY - JOUR
T1 - Gamma-variate plasma clearance versus urinary plasma clearance of 51Cr-EDTA in patients with cirrhosis with and without fluid retention
AU - Fuglsang, Stefan
AU - Henriksen, Ulrik L
AU - Hansen, Hanne Boskov
AU - Bendtsen, Flemming
AU - Henriksen, Jens Henrik Sahl
N1 - © 2016 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd.
PY - 2017/11
Y1 - 2017/11
N2 - In patients with fluid retention, the plasma clearance of 51Cr-EDTA (Clexp obtained by multiexponential fit) may overestimate the glomerular filtration rate (GFR). The present study was undertaken to compare a gamma-variate plasma clearance (Clgv) with the urinary plasma clearance of 51Cr-EDTA (Clu) in patients with cirrhosis with and without fluid retention. A total of 81 patients with cirrhosis (22 without fluid retention, 59 with ascites) received a quantitative intravenous injection of 51Cr-EDTA followed by plasma and quantitative urinary samples for 5 h. Clgv was determined from the injected dose relative to the plasma concentration-time area, obtained by a gamma-variate iterative fit. Clexp and Clu were determined by standard technique. In patients without fluid retention, Clgv, Clexp and Clu were closely similar. The difference between Clgv and Clu (Clgv – Clu = ΔCl) was mean −0·6 ml min−1 1·73 m−2. In patients with ascites, ΔCl was significantly higher (11·8 ml min−1 1·73 m−2, P<0·0001), but this value was lower than Clexp – Clu (17·5 mL min−1 1·73 m−2, P<0·01). ΔCl increased with lower values of GFR (P<0·001). In conclusion, in patients with fluid retention and ascites Clgv and Clexp overestimates GFR substantially, but the overestimation is smaller with Clgv. Although Clu may underestimate GFR slightly, patients with ascites should collect urine quantitatively to obtain a reliable measurement of GFR.
AB - In patients with fluid retention, the plasma clearance of 51Cr-EDTA (Clexp obtained by multiexponential fit) may overestimate the glomerular filtration rate (GFR). The present study was undertaken to compare a gamma-variate plasma clearance (Clgv) with the urinary plasma clearance of 51Cr-EDTA (Clu) in patients with cirrhosis with and without fluid retention. A total of 81 patients with cirrhosis (22 without fluid retention, 59 with ascites) received a quantitative intravenous injection of 51Cr-EDTA followed by plasma and quantitative urinary samples for 5 h. Clgv was determined from the injected dose relative to the plasma concentration-time area, obtained by a gamma-variate iterative fit. Clexp and Clu were determined by standard technique. In patients without fluid retention, Clgv, Clexp and Clu were closely similar. The difference between Clgv and Clu (Clgv – Clu = ΔCl) was mean −0·6 ml min−1 1·73 m−2. In patients with ascites, ΔCl was significantly higher (11·8 ml min−1 1·73 m−2, P<0·0001), but this value was lower than Clexp – Clu (17·5 mL min−1 1·73 m−2, P<0·01). ΔCl increased with lower values of GFR (P<0·001). In conclusion, in patients with fluid retention and ascites Clgv and Clexp overestimates GFR substantially, but the overestimation is smaller with Clgv. Although Clu may underestimate GFR slightly, patients with ascites should collect urine quantitatively to obtain a reliable measurement of GFR.
KW - Journal Article
U2 - 10.1111/cpf.12336
DO - 10.1111/cpf.12336
M3 - Journal article
C2 - 26769593
SN - 1475-0961
VL - 37
SP - 588
EP - 595
JO - Clinical Physiology and Functional Imaging
JF - Clinical Physiology and Functional Imaging
ER -