Determination of optimal sampling times for a two blood sample clearance method using (51)Cr-EDTA in cats

Abstract

Estimation of the glomerular filtration rate (GFR) is a useful tool in the evaluation of kidney function in feline medicine. GFR can be determined by measuring the rate of tracer disappearance from the blood, and although these measurements are generally performed by multi-sampling techniques, simplified methods are more convenient in clinical practice. The optimal times for a simplified sampling strategy with two blood samples (2BS) for GFR measurement in cats using plasma (51)chromium ethylene diamine tetra-acetic acid ((51)Cr-EDTA) clearance were investigated. After intravenous administration of (51)Cr-EDTA, seven blood samples were obtained in 46 cats (19 euthyroid and 27 hyperthyroid cats, none with previously diagnosed chronic kidney disease (CKD)). The plasma clearance was then calculated from the seven point blood kinetics (7BS) and used for comparison to define the optimal sampling strategy by correlating different pairs of time points to the reference method. Mean GFR estimation for the reference method was 3.7+/-2.5 ml/min/kg (mean+/-standard deviation (SD)). Several pairs of sampling times were highly correlated with this reference method (r(2) > or = 0.980), with the best results when the first sample was taken 30 min after tracer injection and the second sample between 198 and 222 min after injection; or with the first sample at 36 min and the second at 234 or 240 min (r(2) for both combinations=0.984). Because of the similarity of GFR values obtained with the 2BS method in comparison to the values obtained with the 7BS reference method, the simplified method may offer an alternative for GFR estimation. Although a wide range of GFR values was found in the included group of cats, the applicability should be confirmed in cats suspected of renal disease and with confirmed CKD. Furthermore, although no indications of age-related effect were found in this study, a possible influence of age should be included in future studies.

Fig 1

TAC of a hyperthyroid cat (estimated GFR 4.0 ml/min/kg, ▪), a euthyroid cat (estimated GFR 2.3 ml/min/kg, ▴), and a euthyroid cat with low estimated GFR (estimated GFR 0.4 ml/min/kg, ♦). Time is represented in the x-axis (h), the plasma activity (in counts/min) in the y-axis.

Fig 2

Bland–Altman plot of the absolute results (in ml/min/kg) of a 7BS and 2BS GFR estimation method using ⁵¹Cr-EDTA. The x-axis represents the average values of the 7BS and 2BS methods; the y-axis represents the difference between the GFR calculated with the 7BS and 2BS methods.