Quality control of slope–intercept measurements of glomerular filtration rate using single-sample estimates

Abstract

Measurement of glomerular filtration rate (GFR) using the slope-intercept technique determines the plasma clearance curve by fitting a straight line to the logarithm of sample count rate. When two samples are used there is no check on the validity of curve fitting. GFR may also be estimated from single-sample concentrations. This study describes a method of quality control for the two-sample technique using the agreement between the one-sample and two-sample estimates. GFR measurements using Tc-DTPA were performed on 225 adults and 100 children using two samples taken between 2 h and 4 h post-injection. The two-sample values obtained using the British Nuclear Medicine Guidelines slope-intercept technique were compared to one-sample estimates obtained using a new general equation. Equations describing the variation of GFR error with GFR value were defined. These were used to determine action levels giving the limits of expected agreement between slope-intercept and single-sample values. The use of these action levels for quality control was demonstrated in a further 120 GFR measurements. The variation of single-sample error estimate with GFR depended both on the time of sample and body surface area. For specific sample groups, the error variation with GFR could be approximated using a truncated quadratic equation. Four studies were identified as failing quality control in the dataset used to define the error equations. Two studies failed in the test dataset. One-sample equations give reliable estimates of GFR, which may be used for quality control of slope-intercept GFR assessment.