Accuracy of iohexol plasma clearance for GFR-determination: a comparison between single and dual sampling

BACKGROUND: Current guidelines regarding plasma-sampling techniques for glomerular filtration rate (GFR) determination are inconsistent. Single-sample methods are commonly believed not to be precise enough to meet clinical demands. The present study compared the agreement between single- and dual- plasma sampling methods with a three-point plasma clearance of iohexol. METHODS: A total of 46 healthy volunteers and 124 chronic kidney disease (CKD) patients with varying degrees of renal dysfunction received 5 ml iohexol (300 mgI/ml) i.v. and plasma samples were drawn at 2-, 3- and 4-h post-injection. Plasma-iodine concentrations were detected by high-performance liquid chromatography (HPLC). RESULTS: Bias was similar among single-plasma sampling methods (SPSM) and dual-plasma sampling methods (DPSM). The best correlation was obtained from the 2- and 4-h DPSM (concordance correlation coefficient [CCC]: 0.9988) with none of the estimates differed by more than 30% from the reference GFR and only one (0.06%) estimate differed by more than 10% (P(30), 100%; P(10), 99.4%). SPSM using samples around 3- or 4-h demonstrated acceptable accuracy at a GFR level of ≥60 ml/min/1.73m(2) (P(30) = 100% and P(10) > 75% for both measurements). CONCLUSION: 4-h SPSM is advantageous in clinical practice in subjects with GFR ≥ 60 ml/min/1.73m(2). For patients with an expected GFR < 60 ml/min/1.73m(2), a prolonged sampling time is more reliable.