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Gamma‐variate plasma clearance versus urinary plasma clearance of 51 Cr‐ EDTA in patients with cirrhosis with and without fluid retention
Author(s) -
Fuglsang Stefan,
Henriksen Ulrik L.,
Hansen Hanne B.,
Bendtsen Flemming,
Henriksen Jens H.
Publication year - 2017
Publication title -
clinical physiology and functional imaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.608
H-Index - 67
eISSN - 1475-097X
pISSN - 1475-0961
DOI - 10.1111/cpf.12336
Subject(s) - renal function , medicine , urology , cirrhosis , ascites , endocrinology , urine , urinary system , urinary retention , gastroenterology
Summary In patients with fluid retention, the plasma clearance of 51 Cr‐ EDTA (Cl exp obtained by multiexponential fit) may overestimate the glomerular filtration rate ( GFR ). The present study was undertaken to compare a gamma‐variate plasma clearance (Cl gv) with the urinary plasma clearance of 51 Cr‐ EDTA (Cl u ) in patients with cirrhosis with and without fluid retention. A total of 81 patients with cirrhosis (22 without fluid retention, 59 with ascites) received a quantitative intravenous injection of 51 Cr‐ EDTA followed by plasma and quantitative urinary samples for 5 h. Cl gv was determined from the injected dose relative to the plasma concentration‐time area, obtained by a gamma‐variate iterative fit. Cl exp and Cl u were determined by standard technique. In patients without fluid retention, Cl gv , Cl exp and Cl u were closely similar. The difference between Cl gv and Cl u (Cl gv – Cl u = ΔCl) was mean −0·6 ml min −1 1·73 m −2 . In patients with ascites, ΔCl was significantly higher (11·8 ml min −1 1·73 m −2 , P <0·0001), but this value was lower than Cl exp – Cl u (17·5 mL min −1 1·73 m −2 , P <0·01). ΔCl increased with lower values of GFR ( P <0·001). In conclusion, in patients with fluid retention and ascites Cl gv and Cl exp overestimates GFR substantially, but the overestimation is smaller with Cl gv . Although Cl u may underestimate GFR slightly, patients with ascites should collect urine quantitatively to obtain a reliable measurement of GFR .