Comparison of Measured Glomerular Filtration Rate Versus Estimated Glomerular Filtration Rate in Indian Cirrhotic Patients: Report of a Pilot Study

Authors

• Smita Divyaveer
• Madhuri Kashyap
• Kushal Kekan
• Ashok K Yadav
• Jaskiran Kaur
• Madhumita Premkumar
• Akash Gandotra
• Kanchan Prajapati
• Arka De
• Ajay K Duseja
• Nipun Verma
• Radhika Aggarwal
• Vaishnavi Venkatasubramanian
• Vaibhav Tiwari
• Vishnuvardhan Bagur
• Amol N Patil
• Nusrat Safiq
• Harbir S Kohli

Language

English

Publication Date

1-1-2025

Journal

Journal of Clinical and Experimental Hepatology

DOI

10.1016/j.jceh.2024.102464

PMID

39760116

PMCID

PMC11697551

PubMedCentral® Posted Date

11-22-2024

PubMedCentral® Full Text Version

Post-print

Abstract

Background: Renal impairment significantly affects morbidity and mortality rates of cirrhosis patients. Studies on glomerular filtration rate (eGFR) estimation did not include cirrhosis patients. These equations are erroneous and unreliable in cirrhosis due to sarcopenia. Further, the accuracy of eGFR equations varies across different ethnic groups. Measurement of GFR by iohexol clearance is a gold standard method of accurate determination of GFR. There is scarce data on iohexol GFR in cirrhosis and none in Indian population.

Methodology: This was prospective observational study. Consecutive adult patients with cirrhosis with stable renal function for prior 1 month were included. Iohexol weight-based dosage was given and timed blood samples were taken to measure iohexol clearance. Plasma iohexol levels was measured by high performance liquid chromatography (HPLC) and Cystatin-C was measured by ELISA in plasma samples.

Results: Thirty-five patients were enrolled in the study. Hepatitis B (n = 5), hepatitis C (n = 4); alcoholic liver disease (n = 20), metabolic dysfunctional associated steatotic liver disease (n = 2), others/overlap (n = 3). The average eGFR by MDRD4, MDRD6, CKD-EPI Creat, CKD EPI Cys C, CKD EPI Creat-Cys C, RFHand GRAIL formulae were 105.24(24.2),104.75(23.5),102.14(15.9),68.91(16.5),82.91(15.21), 67.27 (14.08) and 112.9 (19.5) ml/min ml/min/1.73m2, respectively. The average mGFR measured by iohexol method was 73.44 (16.8)ml/min/1.73 m2. 30% agreement with mGFR was found with eGFR by MDRD4 in 38.2% (n = 13), MDRD6 38.2% ((n = 13), CKD-EPI Creat in 35.2% (n = 12), CKD EPI Cys C in 79.41% (n = 27), CKD EPI Creat-Cys C in 76.42% (n = 26), RFH 76.4% (n = 26) and GRAIL 20.5% (n = 7).

Conclusion: The eGFR equations using creatinine are imprecise and less accurate in Indian patients with cirrhosis. All equations overestimate GFR. Equations especially developed for cirrhosis patients like MDRD6 are also not precise. Cystatin C based equations are better than creatinine-based equations. Further studies with large sample size are needed to establish an accurate method of GFR assessment in Indian patients with cirrhosis.

Keywords

iohexol clearance, mGFR, eGFR, cirrhosis, cystatin- C, MELD

Published Open-Access

yes

Recommended Citation

Divyaveer, Smita; Kashyap, Madhuri; Kekan, Kushal; et al., "Comparison of Measured Glomerular Filtration Rate Versus Estimated Glomerular Filtration Rate in Indian Cirrhotic Patients: Report of a Pilot Study" (2025). Faculty, Staff and Students Publications. 8289.
https://digitalcommons.library.tmc.edu/baylor_docs/8289