Original InvestigationPathogenesis and Treatment of Kidney DiseaseMeasuring GFR: A Systematic Review
Section snippets
Search Strategy
The search strategy was adapted from the PICO process (population [adults, children, elderly, and different patient groups], index test [endogenous creatinine clearance; renal and plasma clearance of 51Cr-EDTA, DTPA, iohexol, and iothalamate; and plasma clearance of inulin], control/reference test [renal inulin clearance], and outcome [bias, precision, and accuracy]). Librarians conducted the literature search in PubMed, Cochrane Library, EMBASE, CINAHL (Cumulative Index to Nursing and Allied
Study Overview
The literature search flow is shown in Fig 1. Population characteristics at study level and individual study quality assessments are available online.3 The assessment of the performance of index methods was based on meta-analysis results for bias, P30, and P10 and is presented in Table 1. The assessment of the accuracy of the index method endogenous creatinine clearance was based on mean bias and is presented in Table 2.
DTPA Clearance
Six studies, including 226 measurements for 174 participants, compared DTPA
Discussion
This systematic review has confirmed that several alternatives to renal inulin clearance exist when a measured GFR is required. The empirical evidence is strong for the renal clearance of iothalamate and moderately strong for renal and plasma clearance of 51Cr-EDTA and plasma clearance of iohexol. The scientific evidence to suggest that renal clearance of iohexol and plasma clearance of inulin can substitute for renal inulin clearance is limited. Similarly, limited evidence suggests that plasma
Acknowledgements
Members of the SBU GFR Review Group are as follows: Carl-Gustaf Elinder (chair), Maria Ahlberg, Susanne Vilhelmsdotter Allander, Anders Alvestrand, Charlotte Asker-Hagelberg, Max Bell, Ulla Berg, Jonas Björk, Agneta Brolund, Sten-Erik Bäck, Thomas Davidson, Nasim Farrokhnia, Anders Grubb, Anders Larsson, Lars-Åke Marké, Ingegerd Mejaré, Patrik Midlöv, Magnus Nord, Anders Norlund, Ulf Nyman, Karin Rydin, Per Sjöström, Inga Soveri, Gunnar Sterner, Maria Svensson, and Sara Wickström; Adjunct
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A list of the members of the Swedish Council on Health Technology Assessment (Swedish abbreviation, SBU) GFR Review Group appears in the Acknowledgements.