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Mannitol clearance for the determination of glomerular filtration rate-a validation against clearance of Cr-51-EDTA

Journal article
Authors Katalin Kiss
M. Molnar
Sören Söndergaard
G. Molnar
Sven-Erik Ricksten
Published in Clinical Physiology and Functional Imaging
Volume 38
Issue 1
Pages 10-16
ISSN 1475-0961
Publication year 2018
Published at Institute of Clinical Sciences, Department of Anesthesiology and Intensive care
Pages 10-16
Language en
Links doi.org/10.1111/cpf.12374
Keywords Cr-51-EDTA, glomerular filtration rate, mannitol, plasma clearance, volume of distribution, acute kidney injury, critically-ill patients, single-plasma sample, enzymatic method, renal clearance, gfr measurement, iohexol, serum, injection, equations, Physiology
Subject categories Anaesthetics

Abstract

We studied the agreement between plasma clearance of mannitol and the reference method, plasma clearance of Cr-51-EDTA in outpatients with normal to moderately impaired renal function. Forty-one patients with a serum creatinine <200moll(-1) entered the study. Cr-51-EDTA clearance was measured with the standard bolus injection technique and glomerular filtration rate (GFR) was calculated by the single-sample method described by Jacobsson. Mannitol, 025gkg(-1) body weight (150mgml(-1)), was infused for 4-14min and blood samples taken at 1-, 2-, 3- and 4-h (n=24) or 2-, 3-, 35- and 4-h after infusion (n=17). Mannitol in serum was measured by an enzymatic method. Plasma clearance for mannitol and its apparent volume of distribution (Vd) were calculated according to BrOchner-Mortensen. Mean plasma clearance (+/- SD) for Cr-51-EDTA was 597 +/- 188mlmin(-1). The mean plasma clearance for mannitol ranged between 570 +/- 201 and 611 +/- 167mlmin(-1) and Vd was 213 +/- 62% per kg b.w. The between-method bias ranged between -023 and 273mlmin(-1), the percentage error between 267 and 395% and the limits of agreement between -143/172 and -253/199mlmin(-1). The best agreement was seen when three- or four-sample measurements of plasma mannitol were obtained and when sampling started 60min after injection. Furthermore, accuracy of plasma clearance determinations was 88-96% (P30) and 41-63% (P10) and was highest when three- or four-sample measurements of plasma mannitol were obtained, including the first hour after the bolus dose. We conclude that there is a good agreement between plasma clearances of mannitol and Cr-51-EDTA for the assessment of GFR.

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