Swan S K, Halstenson C E, Kasiske B L, Collins A J
Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA.
Kidney Int. 1996 Jan;49(1):232-5. doi: 10.1038/ki.1996.32.
Residual renal function (RRF) may contribute significantly to the total dialysis prescription. Conventional quantitation of RRF in hemodialysis (HD) patients is measured by urea clearance and requires a 24-hour urine collection which is often difficult to perform and inaccurate. The renal clearance of iohexol was evaluated as an alternative method for RRF assessment (iohexol-derived RRF) in hemodialysis patients. An intravenous bolus of iohexol (12 ml; 300 mg iodine/ml) was administered to 42 hemodialysis patients following routine HD. A single blood sample was obtained approximately 44 hours later (pre-HD) to determine the plasma clearance of iohexol using x-ray fluorescence methods. Total body clearance of iohexol (CTBio) and non-renal clearance of iohexol (CNRio) 2.87 +/- 0.3 ml/min (mean +/SEM) were used to calculate iohexol-derived RRF (CTBio-CNRio). Iohexol-derived RRF determinations were then compared to urea clearance-derived RRF measurements. The RRF contribution to the dialysis prescription was also calculated utilizing iohexol-derived RRF compared to urea-derived RRF. Iohexol-derived RRF did not differ from urea-derived RRF (2.48 +/- 0.3 vs. 2.64 +/- 0.4 ml/min, P = 0.21). The RRF contribution to the weekly dialysis prescription (Kt/V) did not differ when iohexol-derived RRF was compared to urea-derived RRF (0.94 +/- 0.1 vs. 0.93 +/- 0.1, P = 0.9). Additionally, the effect of iohexol on RRF was assessed in 17 HD patients. Urea-derived RRF determinations one week after iohexol exposure did not differ from those measured one week prior to iohexol exposure (3.17 +/- 0.6 vs. 2.91 +/- 0.5 ml/min, respectively). Thus, renal clearance of iohexol can be an accurate and safe measure of RRF in HD patients and potentially simplify delivery of the dialysis prescription.
残余肾功能（RRF）可能对总透析处方有显著贡献。血液透析（HD）患者中RRF的传统定量方法是通过尿素清除率来测量，这需要收集24小时尿液，而这往往很难做到且不准确。在血液透析患者中，对碘海醇的肾清除率作为评估RRF的替代方法（碘海醇衍生的RRF）进行了评估。在常规HD后，对42例血液透析患者静脉推注碘海醇（12 ml；300 mg碘/ml）。大约44小时后（HD前）采集一份血样，使用X射线荧光法测定碘海醇的血浆清除率。碘海醇的全身清除率（CTBio）和碘海醇的非肾清除率（CNRio）为2.87±0.3 ml/分钟（平均值±标准误），用于计算碘海醇衍生的RRF（CTBio - CNRio）。然后将碘海醇衍生的RRF测定结果与尿素清除率衍生的RRF测量结果进行比较。与尿素衍生的RRF相比，还利用碘海醇衍生的RRF计算了RRF对透析处方的贡献。碘海醇衍生的RRF与尿素衍生的RRF无差异（2.48±0.3对2.64±0.4 ml/分钟，P = 0.21）。当将碘海醇衍生的RRF与尿素衍生的RRF进行比较时，RRF对每周透析处方（Kt/V）的贡献无差异（0.94±0.1对0.93±0.1，P = 0.9）。此外，在17例HD患者中评估了碘海醇对RRF的影响。碘海醇暴露一周后的尿素衍生RRF测定结果与碘海醇暴露前一周测量的结果无差异（分别为3.17±0.6对2.91±0.5 ml/分钟）。因此，碘海醇的肾清除率可以是血液透析患者RRF的一种准确且安全的测量方法，并有可能简化透析处方的制定。
