Published online Aug 27, 2022. doi: 10.4254/wjh.v14.i8.1621
Peer-review started: March 16, 2022
First decision: April 28, 2022
Revised: May 11, 2022
Accepted: June 24, 2022
Article in press: June 24, 2022
Published online: August 27, 2022
Processing time: 162 Days and 18.1 Hours
To date, no method for measuring the glomerular filtration rate (GFR) based on either creatinine or an exogenous marker, which is both reliable and applicable in clinical practice in cirrhotic patients with different degrees of decompensation, is available.
We urgently need accurate methods to measure GFR in cirrhotic patients; renal failure being a key prognostic factor in decompensated cirrhosis, particularly in the pre and post-transplant period.
Describing the complete pharmacokinetic (PK) study of iohexol in blood and urine as an appropriate and inexpensive marker is essential to subsequently construct a PK model from a limited number of samples.
This pilot study included nine patients with different ascites grades, who received a single 5-mL bolus of iohexol, with the collection of 11 blood samples and all the urine volume (in four samples) over a period of 24 h.
Iohexol was almost no longer detected in plasma at 24 h that allowed us to extrapolate the area under the curve (AUC) 0–24 h to AUC 0–∞. The dose recovery in urine varied from 60% to 90% of the dose injected. The correlation between urine clearance and iohexol plasma clearance was strong. As expected, a low correlation with the estimated GFR (eGFR) calculated by creatinine-based equations was observed contrary to the Brochner–Mortensen (BM) equation, which exhibited a high correlation.
This study confirmed the relevance of the plasma clearance of iohexol in the cirrhotic population. It also suggests a high accuracy of the BM equation and confirms the low correlation with eGFR estimated by creatinine-based equations.
A future study based on a larger cohort of cirrhotic patients with different ascites grades will be performed to devise a PK model allowing the estimation of iohexol plasma clearance from a limited number of samples and to investigate the performance of the BM equation.