Continuous Infusion of Low-Dose Iohexol Measures Changing Glomerular Filtration Rate in Critically Ill Patients. Issue 3 (March 2018)

• Record Type: Journal Article
• Authors: Dixon, John J.; Lane, Katie; Dalton, R. Neil; Turner, Charles; MacPhee, Iain A. M.; Chis Ster, Irina; Philips, Barbara J.
• Is Part Of: Critical care medicine. Volume 46:Issue 3(2018)
• Publication Date: 2018-03
• Subjects: acute kidney injury -- glomerular filtration rate -- Iohexol; Critical care medicine -- Periodicals; Soins intensifs -- Périodiques; 616.028
• DOI: 10.1097/CCM.0000000000002870
• Languages: English
• ISSNs: 0090-3493

Abstract

Abstract : Objective: Measurement of changing glomerular filtration rate in acute kidney injury remains problematic. We have previously used a continuous infusion of low-dose Iohexol to measure glomerular filtration rate in stable subjects and postulate that changes greater than 10.3% in critically ill patients indicate acute kidney injury. Our objective is to explore the extent to which continuous infusion of low-dose Iohexol can be a measure of changing glomerular filtration rate during acute kidney injury. Design: Clinical observational exploratory study. Setting: Adult ICU. Patients: Three patient groups were recruited: nephrectomy group: predictable onset of acute kidney injury and outcome ( n = 10); surgery group: predictable onset of acute kidney injury, unpredictable outcome ( n = 11); and acute kidney injury group: unpredictable onset of acute kidney injury and outcome ( n = 13). Interventions: Continuous infusion of low-dose Iohexol was administered for 24–80 hours. Plasma (ClP ) and renal (ClR ) Iohexol clearances were measured at timed intervals. Measurements and Main Results: Kidney Disease: Improved Global Outcomes acute kidney injury criteria were fulfilled in 22 patients (nephrectomy = 5, surgery = 4, and acute kidney injury = 13); continuous infusion of low-dose Iohexol demonstrated acute kidney injury in 29 patients (nephrectomy = 10, surgery = 8, acute kidney injury = 11). Dynamic changes in glomerular filtration rate were tracked in all patients. In the nephrectomy group, ClR decreased by an expected 50% (50.8% ± 11.0%). Agreement between ClP and ClR improved with increasing duration of infusion: bias of ClP versus ClR at 48 hours was –0.1 ± 3.6 mL/min/1.73 m 2 (limits of agreement: –7.2 to 7.1 mL/min/1.73 m 2 ). Coefficient of variation of laboratory sample analysis was 2.4%. Conclusions: Continuous infusion of low-dose Iohexol is accurate and precise when measuring glomerular filtration rate and tracks changes in patients with differing risks of acute kidney injury. Continuous infusion of low-dose Iohexol may provide a useful standard against which to test novel biomarkers for the diagnosis of acute kidney injury. Abstract : Supplemental Digital Content is available in the text.