Radiopharmacie, Pharmacie, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France.
Faculté de Médecine, Université Paris Cité, Paris, France.
J Nephrol. 2023 Dec;36(9):2457-2465. doi: 10.1007/s40620-023-01612-0. Epub 2023 Apr 24.
In late 2018, the production of Chromium-labelled ethylenediamine tetra-acetic acid (Cr-EDTA), a validated and widely used radio-isotopic tracer for measuring glomerular filtration rate, was halted. Technetium-99m-diethylenetriaminepentaacetic acid (Tc-DTPA) has been validated for GFR measurement with a single bolus injection, a procedure not suitable in patients with extracellular compartment hyperhydration. In such cases, a bolus followed by continuous infusion of the tracer is required. The aim of this study was to evaluate whether Tc-DTPA with the infusion protocol can replace Cr-EDTA for GFR measurement.
We conducted a prospective single centre study during February and March 2019. All patients referred for GFR measurement received both radiotracers simultaneously: Cr-EDTA and Tc-DTPA bolus and continuous infusion were administered concomitantly through the same intravenous route. Over four and a half hours, plasma and urine samples were collected to calculate urinary and plasma clearance.
Twenty-two patients were included (mean age 63.4 ± 17.5 years; 68% men). Mean urinary clearance of Cr-EDTA and Tc-DTPA was 52.4 ± 22.5 mL/min and 52.8 ± 22.6 mL/min, respectively (p = 0.47), with a mean bias of 0.39 ± 2.50 mL/min, an accuracy within 10% of 100% (95% CI 100; 100) and a Pearson correlation coefficient of 0.994. Mean plasma clearance of Cr-EDTA and Tc-DTPA was 54.8 ± 20.9 mL/min and 54.4 ± 20.9 mL/min, respectively (p = 0.61), with a mean bias of - 0.43 ± 3.89 mL/min, an accuracy within 10% of 77% (95% CI 59; 91) and a Pearson correlation coefficient of 0.983.
Urinary and plasma clearance of Tc-DTPA can be used with the infusion protocol to measure GFR.
2018 年末，用于测量肾小球滤过率的放射性同位素示踪剂铬标记乙二胺四乙酸（Cr-EDTA）的生产停止。锝-99m-二乙三胺五乙酸（Tc-DTPA）已通过单次推注验证可用于 GFR 测量，但该方法不适合细胞外腔液过多的患者。在这种情况下，需要推注后连续输注示踪剂。本研究旨在评估连续输注方案的 Tc-DTPA 是否可替代 Cr-EDTA 用于 GFR 测量。
我们于 2019 年 2 月至 3 月进行了一项前瞻性单中心研究。所有转至本中心进行 GFR 测量的患者均同时接受两种放射性示踪剂：Cr-EDTA 和 Tc-DTPA 推注及连续输注同时通过同一条静脉途径给予。在 4 个半小时内，收集血浆和尿液样本以计算尿和血浆清除率。
共纳入 22 例患者（平均年龄 63.4±17.5 岁；68%为男性）。Cr-EDTA 和 Tc-DTPA 的平均尿清除率分别为 52.4±22.5mL/min 和 52.8±22.6mL/min（p=0.47），平均偏差为 0.39±2.50mL/min，准确度在 10%范围内为 100%（95%CI 100；100），Pearson 相关系数为 0.994。Cr-EDTA 和 Tc-DTPA 的平均血浆清除率分别为 54.8±20.9mL/min 和 54.4±20.9mL/min（p=0.61），平均偏差为-0.43±3.89mL/min，准确度在 10%范围内为 77%（95%CI 59；91），Pearson 相关系数为 0.983。
连续输注方案下 Tc-DTPA 的尿和血浆清除率可用于测量 GFR。
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