TY - JOUR
T1 - Measured glomerular filtration rate
T2 - The query for a workable golden standard technique
AU - Speeckaert, Marijn M.
AU - Seegmiller, Jesse
AU - Glorieux, Griet
AU - Lameire, Norbert
AU - Van Biesen, Wim
AU - Vanholder, Raymond
AU - Delanghe, Joris R.
N1 - Publisher Copyright:
© 2021 by the authors. Licensee MDPI, Basel, Switzerland.
PY - 2021/10
Y1 - 2021/10
N2 - Inulin clearance has, for a long time, been considered as the reference method to determine measured glomerular filtration rates (mGFRs). However, given the known limitations of the standard marker, serum creatinine, and of inulin itself, and the frequent need for accurate GFR estimations, several other non-radioactive (iohexol and iothalamate) and radioactive (51Cr-EDTA,99mTc-DTPA,125 I iothalamate) exogenous mGFR filtration markers are nowadays considered the most accurate options to evaluate GFR. The availability of51Cr-EDTA is limited, and all methods using radioactive tracers necessitate specific safety precautions. Serum-or plasma-based certified reference materials for iohexol and iothalamate and evidence-based protocols to accurately and robustly measure GFR (plasma vs. urinary clearance, single-sample vs. multiple-sample strategy, effect of sampling time delay) are lacking. This leads to substantial variation in reported mGFR results across studies and questions the scientific reliability of the alternative mGFR methods as the gold standard to evaluate kidney function. On top of the scientific discussion, regulatory issues are further narrowing the clinical use of mGFR methods. Therefore, this review is a call for standardization of mGFR in terms of three aspects: the marker, the analytical method to assess concentrations of that marker, and the procedure to determine GFR in practice. Moreover, there is also a need for an endogenous filtration marker or a panel of filtration markers from a single blood draw that would allow estimation of GFR as accurately as mGFR, and without the need for application of anthropometric, clinical, and demographic characteristics.
AB - Inulin clearance has, for a long time, been considered as the reference method to determine measured glomerular filtration rates (mGFRs). However, given the known limitations of the standard marker, serum creatinine, and of inulin itself, and the frequent need for accurate GFR estimations, several other non-radioactive (iohexol and iothalamate) and radioactive (51Cr-EDTA,99mTc-DTPA,125 I iothalamate) exogenous mGFR filtration markers are nowadays considered the most accurate options to evaluate GFR. The availability of51Cr-EDTA is limited, and all methods using radioactive tracers necessitate specific safety precautions. Serum-or plasma-based certified reference materials for iohexol and iothalamate and evidence-based protocols to accurately and robustly measure GFR (plasma vs. urinary clearance, single-sample vs. multiple-sample strategy, effect of sampling time delay) are lacking. This leads to substantial variation in reported mGFR results across studies and questions the scientific reliability of the alternative mGFR methods as the gold standard to evaluate kidney function. On top of the scientific discussion, regulatory issues are further narrowing the clinical use of mGFR methods. Therefore, this review is a call for standardization of mGFR in terms of three aspects: the marker, the analytical method to assess concentrations of that marker, and the procedure to determine GFR in practice. Moreover, there is also a need for an endogenous filtration marker or a panel of filtration markers from a single blood draw that would allow estimation of GFR as accurately as mGFR, and without the need for application of anthropometric, clinical, and demographic characteristics.
KW - Contrast media
KW - Glomerular filtration rate
KW - Inulin
KW - Radioactive tracers
UR - http://www.scopus.com/inward/record.url?scp=85116058232&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85116058232&partnerID=8YFLogxK
U2 - 10.3390/jpm11100949
DO - 10.3390/jpm11100949
M3 - Review article
C2 - 34683089
AN - SCOPUS:85116058232
SN - 2075-4426
VL - 11
JO - Journal of Personalized Medicine
JF - Journal of Personalized Medicine
IS - 10
M1 - 949
ER -