Kågedal Bertil, Helldén Anders, Nezirević Dernroth Dženeta, Lindgaard Andersen Anders, Ekman Andreas, Haglund Mats, Kataria Bharti, Oskarsson Frida, Tobieson Lovisa, Östholm Åse, Hanberger Håkan
Department of Biomedical and Clinical Science, Division of Clinical Chemistry and Clinical Pharmacology, Linköping University, Linköping, Sweden.
Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska University Hospital Huddinge, Karolinska Institutet, Stockholm, Sweden.
Crit Care Explor. 2025 May 14;7(5):e1269. doi: 10.1097/CCE.0000000000001269. eCollection 2025 May 1.
To measure glomerular filtration rate using iohexol plasma clearance (mGFRiohexol) in critically ill patients using the high doses of iohexol administered at CT and to evaluate its agreements with urinary creatinine clearance (uClcr) and estimated glomerular filtration rates (eGFRs), calculated from plasma concentrations of creatinine (eGFRcr) and cystatin C (eGFRcys).
Prospective observational cohort study.
ICUs across Southeast Sweden.
Critically ill adult patients.
Twenty-six ICU patients were given high doses of iohexol (range, 27-140 mL) for contrast-enhanced CT, whereafter blood samples were taken in the elimination phase for determination of mGFRiohexol. Plasma iohexol concentrations were determined by high-performance liquid chromatography and mGFRiohexol was calculated. Standard dose (5 mL) of iohexol was administered the following days to compare low-dose clearance results with the high-dose clearance results. Six-hour uClcr was performed four times a day and averaged.
Mean ± sd mGFRiohexol after CT was 77.4 ± 38.1 mL/min (n = 26), and uClcr was 97.3 ± 58.2 mL/min (n = 25) in the critically ill patients. There was a strong positive correlation between mGFRiohexol determined with high and low doses of iohexol in patients with normal or high mGFRiohexol (coefficient of determination [R2] = 0.88; p < 0.001) and between mGFRiohexol and uClcr (R2 = 0.87; p < 0.001). eGFRcr overestimated mGFRiohexol and eGFRcys underestimated mGFRiohexol.
mGFRiohexol after contrast-enhanced CT compares well with mGFRiohexol after standard low-dose iohexol respectively uClcr. Over- and underestimation of mGFRiohexol by eGFRcr and eGFRcys is probably explained by increased tubular secretion of creatinine and increased production of cystatin C in intensive care patients.
在接受CT检查时给予大剂量碘海醇的危重症患者中，采用碘海醇血浆清除率（mGFRiohexol）来测定肾小球滤过率，并评估其与尿肌酐清除率（uClcr）以及根据血浆肌酐浓度（eGFRcr）和胱抑素C（eGFRcys）计算得出的估算肾小球滤过率（eGFRs）之间的一致性。
前瞻性观察性队列研究。
瑞典东南部的重症监护病房。
成年危重症患者。
26例重症监护病房患者在进行增强CT检查时接受了大剂量碘海醇（范围为27 - 140 mL），之后在消除期采集血样以测定mGFRiohexol。通过高效液相色谱法测定血浆碘海醇浓度，并计算mGFRiohexol。在接下来的几天给予标准剂量（5 mL）碘海醇，以比较低剂量清除结果与高剂量清除结果。每天进行4次6小时的uClcr测定并取平均值。
危重症患者CT检查后mGFRiohexol的平均值±标准差为77.4 ± 38.1 mL/min（n = 26），uClcr为97.3 ± 58.2 mL/min（n = 25）。在mGFRiohexol正常或较高的患者中，高剂量和低剂量碘海醇测定的mGFRiohexol之间存在强正相关（决定系数[R2] = 0.88；p < 0.001），mGFRiohexol与uClcr之间也存在强正相关（R2 = 0.87；p < 0.001）。eGFRcr高估了mGFRiohexol，而eGFRcys低估了mGFRiohexol。
增强CT检查后的mGFRiohexol与标准低剂量碘海醇后的mGFRiohexol以及uClcr相比表现良好。eGFRcr和eGFRcys对mGFRiohexol的高估和低估可能是由于重症监护患者中肌酐肾小管分泌增加和胱抑素C产生增加所致。
