Jakobsen Kjellbjørn, Eriksen Bjørn O, Fuskevåg Ole M, Hodges Stephen J, Ytrebø Lars M
Anesthesia and Critical Care Research Group, UiT - The Arctic University of Norway, Tromsø, Norway.
Metabolic and Renal Research Group, UiT - the Arctic University of Norway, Tromsø, Norway.
Int J Nephrol. 2022 May 24;2022:8267829. doi: 10.1155/2022/8267829. eCollection 2022.
Continuous monitoring of the glomerular filtration rate (GFR) in the perioperative setting could provide valuable information about acute kidney injury risk for both clinical and research purposes. This pilot study aimed to demonstrate that GFR measurement by a continuous 72 hrs iohexol infusion in patients undergoing colorectal cancer surgery is feasible. Four patients undergoing robot-assisted colorectal cancer surgery were recruited from elective surgery listings. GFR was determined preoperatively by the single-sample iohexol clearance method, and postoperatively at timed intervals by a continuous iohexol infusion for 72 hrs. Plasma concentrations of creatinine and cystatin C were measured concurrently. GFR was calculated as (iohexol infusion rate (mg/min))/(plasma iohexol concentration (mg/mL)). The association of the three different filtration markers and GFR with time were analysed in generalized additive mixed models. The continuous infusion of iohexol was established in all four patients and maintained throughout the study period without interfering with ordinary postoperative care. Postoperative GFR at 2 hours were elevated compared to the preoperative measurements for patients 1, 2, and 3, but not for patient 4. Whereas patients 1, 2, and 3 had u-shaped postoperative mGFR curves, patient 4 demonstrated a linear increase in mGFR with time. We conclude that obtaining continuous measurements of GFR in the postoperative setting is feasible and can detect variations in GFR. The method can be used as a tool to track perioperative changes in renal function.
在围手术期持续监测肾小球滤过率（GFR）可为临床和研究目的提供有关急性肾损伤风险的有价值信息。这项初步研究旨在证明，对接受结直肠癌手术的患者进行连续72小时碘海醇输注以测量GFR是可行的。从择期手术名单中招募了4名接受机器人辅助结直肠癌手术的患者。术前通过单样本碘海醇清除率法测定GFR，术后通过连续72小时输注碘海醇按时间间隔测定GFR。同时测量血浆肌酐和胱抑素C浓度。GFR的计算方法为（碘海醇输注速率（mg/分钟））/（血浆碘海醇浓度（mg/mL））。在广义相加混合模型中分析了三种不同滤过标志物与GFR随时间的关联。所有4名患者均成功建立了碘海醇连续输注，并在整个研究期间维持，且未干扰术后常规护理。与术前测量值相比，患者1、2和3术后2小时的GFR升高，但患者4没有。患者1、2和3的术后平均GFR（mGFR）曲线呈U形，而患者4的mGFR随时间呈线性增加。我们得出结论，在术后环境中获得GFR连续测量值是可行的，并且可以检测到GFR的变化。该方法可作为追踪围手术期肾功能变化的工具。
