Determination of Glomerular Filtration Rate After Contrast-Enhanced CT Among Critically Ill Patients: Support for a New Procedure
OBJECTIVES:. To measure glomerular filtration rate using iohexol plasma clearance (mGFRiohexol) in critically ill patients using the high doses of iohexol administered at CT and to evaluate its agreements with urinary creatinine clearance (uClcr) and estimated glomerular filtration rates (eGFRs), ca...
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| Format: | Article |
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Wolters Kluwer
2025-05-01
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| Series: | Critical Care Explorations |
| Online Access: | http://journals.lww.com/10.1097/CCE.0000000000001269 |
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| author | Bertil Kågedal, MD, PhD Anders Helldén, MD, PhD Dženeta Nezirević Dernroth, PhD Anders Lindgaard Andersen, MD Andreas Ekman, MD, PhD, DEAA Mats Haglund, MD, PhD Bharti Kataria, PhD Frida Oskarsson, MD Lovisa Tobieson, MD, PhD Åse Östholm, MD, PhD Håkan Hanberger, MD, PhD |
| author_facet | Bertil Kågedal, MD, PhD Anders Helldén, MD, PhD Dženeta Nezirević Dernroth, PhD Anders Lindgaard Andersen, MD Andreas Ekman, MD, PhD, DEAA Mats Haglund, MD, PhD Bharti Kataria, PhD Frida Oskarsson, MD Lovisa Tobieson, MD, PhD Åse Östholm, MD, PhD Håkan Hanberger, MD, PhD |
| author_sort | Bertil Kågedal, MD, PhD |
| collection | DOAJ |
| description | OBJECTIVES:. To measure glomerular filtration rate using iohexol plasma clearance (mGFRiohexol) in critically ill patients using the high doses of iohexol administered at CT and to evaluate its agreements with urinary creatinine clearance (uClcr) and estimated glomerular filtration rates (eGFRs), calculated from plasma concentrations of creatinine (eGFRcr) and cystatin C (eGFRcys).
DESIGN:. Prospective observational cohort study.
SETTING:. ICUs across Southeast Sweden.
PATIENTS:. Critically ill adult patients.
INTERVENTIONS AND MEASUREMENTS:. Twenty-six ICU patients were given high doses of iohexol (range, 27–140 mL) for contrast-enhanced CT, whereafter blood samples were taken in the elimination phase for determination of mGFRiohexol. Plasma iohexol concentrations were determined by high-performance liquid chromatography and mGFRiohexol was calculated. Standard dose (5 mL) of iohexol was administered the following days to compare low-dose clearance results with the high-dose clearance results. Six-hour uClcr was performed four times a day and averaged.
MAIN RESULTS:. Mean ± sd mGFRiohexol after CT was 77.4 ± 38.1 mL/min (n = 26), and uClcr was 97.3 ± 58.2 mL/min (n = 25) in the critically ill patients. There was a strong positive correlation between mGFRiohexol determined with high and low doses of iohexol in patients with normal or high mGFRiohexol (coefficient of determination [R2] = 0.88; p < 0.001) and between mGFRiohexol and uClcr (R2 = 0.87; p < 0.001). eGFRcr overestimated mGFRiohexol and eGFRcys underestimated mGFRiohexol.
CONCLUSIONS:. mGFRiohexol after contrast-enhanced CT compares well with mGFRiohexol after standard low-dose iohexol respectively uClcr. Over- and underestimation of mGFRiohexol by eGFRcr and eGFRcys is probably explained by increased tubular secretion of creatinine and increased production of cystatin C in intensive care patients. |
| format | Article |
| id | doaj-art-0d67e0c2a1cb4dc2b6e4565a4b253463 |
| institution | OA Journals |
| issn | 2639-8028 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Critical Care Explorations |
| spelling | doaj-art-0d67e0c2a1cb4dc2b6e4565a4b2534632025-08-20T02:29:12ZengWolters KluwerCritical Care Explorations2639-80282025-05-0175e126910.1097/CCE.0000000000001269202505000-00012Determination of Glomerular Filtration Rate After Contrast-Enhanced CT Among Critically Ill Patients: Support for a New ProcedureBertil Kågedal, MD, PhD0Anders Helldén, MD, PhD1Dženeta Nezirević Dernroth, PhD2Anders Lindgaard Andersen, MD3Andreas Ekman, MD, PhD, DEAA4Mats Haglund, MD, PhD5Bharti Kataria, PhD6Frida Oskarsson, MD7Lovisa Tobieson, MD, PhD8Åse Östholm, MD, PhD9Håkan Hanberger, MD, PhD101 Department of Biomedical and Clinical Science, Division of Clinical Chemistry and Clinical Pharmacology, Linköping University, Linköping, Sweden.1 Department of Biomedical and Clinical Science, Division of Clinical Chemistry and Clinical Pharmacology, Linköping University, Linköping, Sweden.1 Department of Biomedical and Clinical Science, Division of Clinical Chemistry and Clinical Pharmacology, Linköping University, Linköping, Sweden.3 Department of Anesthesia and Intensive Care, Växjö County Hospital, Växjö, Sweden.4 Department of Anesthesia and Intensive Care, Kalmar County Hospital, Kalmar, Sweden.7 Department of Infectious Diseases, Kalmar County Hospital, Kalmar, Sweden.8 Centre for Medical Image Science and Visualization (CMIV), Department of Radiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.3 Department of Anesthesia and Intensive Care, Växjö County Hospital, Växjö, Sweden.9 Department of Neurosurgery and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.10 Department of Infectious Diseases, Linköping University, Linköping, Sweden.10 Department of Infectious Diseases, Linköping University, Linköping, Sweden.OBJECTIVES:. To measure glomerular filtration rate using iohexol plasma clearance (mGFRiohexol) in critically ill patients using the high doses of iohexol administered at CT and to evaluate its agreements with urinary creatinine clearance (uClcr) and estimated glomerular filtration rates (eGFRs), calculated from plasma concentrations of creatinine (eGFRcr) and cystatin C (eGFRcys). DESIGN:. Prospective observational cohort study. SETTING:. ICUs across Southeast Sweden. PATIENTS:. Critically ill adult patients. INTERVENTIONS AND MEASUREMENTS:. Twenty-six ICU patients were given high doses of iohexol (range, 27–140 mL) for contrast-enhanced CT, whereafter blood samples were taken in the elimination phase for determination of mGFRiohexol. Plasma iohexol concentrations were determined by high-performance liquid chromatography and mGFRiohexol was calculated. Standard dose (5 mL) of iohexol was administered the following days to compare low-dose clearance results with the high-dose clearance results. Six-hour uClcr was performed four times a day and averaged. MAIN RESULTS:. Mean ± sd mGFRiohexol after CT was 77.4 ± 38.1 mL/min (n = 26), and uClcr was 97.3 ± 58.2 mL/min (n = 25) in the critically ill patients. There was a strong positive correlation between mGFRiohexol determined with high and low doses of iohexol in patients with normal or high mGFRiohexol (coefficient of determination [R2] = 0.88; p < 0.001) and between mGFRiohexol and uClcr (R2 = 0.87; p < 0.001). eGFRcr overestimated mGFRiohexol and eGFRcys underestimated mGFRiohexol. CONCLUSIONS:. mGFRiohexol after contrast-enhanced CT compares well with mGFRiohexol after standard low-dose iohexol respectively uClcr. Over- and underestimation of mGFRiohexol by eGFRcr and eGFRcys is probably explained by increased tubular secretion of creatinine and increased production of cystatin C in intensive care patients.http://journals.lww.com/10.1097/CCE.0000000000001269 |
| spellingShingle | Bertil Kågedal, MD, PhD Anders Helldén, MD, PhD Dženeta Nezirević Dernroth, PhD Anders Lindgaard Andersen, MD Andreas Ekman, MD, PhD, DEAA Mats Haglund, MD, PhD Bharti Kataria, PhD Frida Oskarsson, MD Lovisa Tobieson, MD, PhD Åse Östholm, MD, PhD Håkan Hanberger, MD, PhD Determination of Glomerular Filtration Rate After Contrast-Enhanced CT Among Critically Ill Patients: Support for a New Procedure Critical Care Explorations |
| title | Determination of Glomerular Filtration Rate After Contrast-Enhanced CT Among Critically Ill Patients: Support for a New Procedure |
| title_full | Determination of Glomerular Filtration Rate After Contrast-Enhanced CT Among Critically Ill Patients: Support for a New Procedure |
| title_fullStr | Determination of Glomerular Filtration Rate After Contrast-Enhanced CT Among Critically Ill Patients: Support for a New Procedure |
| title_full_unstemmed | Determination of Glomerular Filtration Rate After Contrast-Enhanced CT Among Critically Ill Patients: Support for a New Procedure |
| title_short | Determination of Glomerular Filtration Rate After Contrast-Enhanced CT Among Critically Ill Patients: Support for a New Procedure |
| title_sort | determination of glomerular filtration rate after contrast enhanced ct among critically ill patients support for a new procedure |
| url | http://journals.lww.com/10.1097/CCE.0000000000001269 |
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