Constant infusion clearance is an inappropriate method for accurate assessment of an impaired glomerular filtration rate

Abstract

Recently renewed interest has been focused on constant infusion clearance to assess GFR accurately. In this study we compared GFR and ERPF calculated from the constant infusion method (CIM = I x V/P) with that calculated from the standard method (StM = U x V/P), in 100 patients with renal disease who were subdivided in four groups according to their GFR-StM (< 30; 30-60; 60-90; > 90 ml/min). After a priming dose, a constant infusion of 125I-iothalamate (= GFR) and 131I-hippurate (= ERPF) was started at 9 a.m. The infusion rates were individually adjusted to the GFR which was approximated from the serum creatinine concentration. After a 90-min equilibration period, GFR-StM and ERPF-StM were determined for two 2-h periods. These values were compared with GFR-CIM and ERPF-CIM calculated from the plasma concentration of the respective tracers at the end of each 2-h period (= 210 and 330 min). In the patient group with GFR-StM < 30 ml/min, the 125I-iothalamate plasma concentration increased progressively over time. Consequently, average GFR-CIM at 210 min (34.2, SE +/- 2.1 ml/min) was higher than the GFR-CIM at 330 min (31.9, SE +/- 2.0 ml/min; P < 0.001). In addition both values were significantly higher than the corresponding GFR-StM values (18.1 +/- 2.4 and 15.3 +/- 1.6 ml/min respectively). In the two patient groups with GFR-StM > 60 ml/min, the 125I-iothalamate plasma concentration decreased progressively over time.(ABSTRACT TRUNCATED AT 250 WORDS)