Niculescu-Duvaz I, D'Mello L, Maan Z, Barron J L, Newman D J, Dockrell M E C, Kwan J T C
South West Thames Institute for Renal Research, St Heller Hospital, Carshalton, Surrey, UK.
Kidney Int. 2006 Apr;69(7):1272-5. doi: 10.1038/sj.ki.5000240.
Development of an outpatient finger-prick glomerular filtration rate (GFR) procedure suitable for epidemiological studies. In clinical practice, reference GFR procedures are rarely used; in large-scale research studies, a great deal of effort and experience is required to obtain them, which is a considerable disincentive to using GFR as an end point. The major problem for both clinical staff and the subject is the length of time that the procedure takes, requiring continuous attendance in the outpatient clinic or its vicinity. Using iohexol as a marker, we therefore propose an alternative approach, which addresses this fundamental deterrent to a more widespread use of GFR measurement. Eighty-two GFR measurements were performed in a mixture of healthy subjects and patients with differing degrees of renal impairment with a wide range of GFRs. Serum was obtained from blood samples to enable a reference GFR to be calculated. Blood spots were collected on filter paper at the same intervals (120, 180, and 240 min), allowed to dry, and then sent through the post. Serum and blood spots were analyzed simultaneously for each individual by automated reverse-phase high-pressure liquid chromatography. Standard linear regression analyses confirmed a good agreement (r2 = 0.953) between the iohexol serum GFR and iohexol blood spots GFR. Bland-Altman analysis confirmed that there was no concentration bias. Paired comparisons (Wilcoxon's paired signed rank test) showed no significant difference between the two measurements. Capillary sampling is simple, effective, and significantly reduces the time and costs of performing plasma clearance GFR measurements. This approach will make the GFR measurement more accessible for clinical practice and large-scale epidemiological studies may become feasible.
开发一种适用于流行病学研究的门诊手指采血肾小球滤过率（GFR）检测方法。在临床实践中，很少使用参考GFR检测方法；在大规模研究中，获取这些方法需要大量的努力和经验，这对将GFR用作终点指标是一个很大的阻碍。临床工作人员和受试者面临的主要问题是该检测过程所需的时间长度，需要在门诊或其附近持续就诊。因此，我们使用碘海醇作为标志物，提出了一种替代方法，该方法解决了更广泛使用GFR测量的这一基本阻碍。在健康受试者和不同程度肾功能损害患者的混合群体中进行了82次GFR测量，这些患者的GFR范围广泛。从血样中获取血清以计算参考GFR。在相同时间间隔（120、180和240分钟）采集滤纸血斑，使其干燥，然后邮寄。通过自动反相高压液相色谱法对每个个体的血清和血斑同时进行分析。标准线性回归分析证实碘海醇血清GFR和碘海醇血斑GFR之间具有良好的一致性（r2 = 0.953）。Bland-Altman分析证实不存在浓度偏差。配对比较（Wilcoxon配对符号秩检验）显示两次测量之间无显著差异。毛细血管采样简单、有效，显著减少了进行血浆清除率GFR测量的时间和成本。这种方法将使GFR测量在临床实践中更容易实现，大规模流行病学研究可能变得可行。
