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Estimating GFR prior to contrast medium examinations—what the radiologist needs to know!

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A Correction to this article was published on 16 March 2021

This article has been updated

Abstract

Creatinine-based equations to estimate glomerular filtration rate (GFR) are increasingly used in radiological practice and in studies on contrast medium-induced acute kidney injury (CIAKI). Their use is recommended in guidelines and contrast medium textbooks to identify patients at risk of CIAKI or nephrogenic systemic fibrosis. There is also an increased interest in cystatin C-based equations. Adopting GFR equations requires local creatinine and cystatin C assay calibrations to equal those used in developing the equations to avoid overestimation or underestimation of renal function. Methods should preferably be traceable to international standards, and assay traceability should be defined in CIAKI studies. Absolute GFR (mL/min) should be used when dosing contrast media and relating the dose to CIAKI instead of commonly used relative GFR (mL/min/1.73 m2) estimates. Accuracy of creatinine and cystatin C equations (percentage of GFR estimates within 30 % of measured GFR) ranges between 75 % and 85 %. Equations combining creatinine and cystatin C may reach 90 %, an accuracy similar to clearance methods (used as a reference test when developing and validating equations) when compared to the gold standard, renal clearance of inulin. The local laboratory or nephrology experts should be consulted in matters of method calibration and choice of GFR equation.

Key Points

• Traceability of creatinine/cystatin C assays used in GFR equations must be defined.

• Absolute, not relative, GFR should be used when dosing contrast media.

• Consult the local laboratory or nephrologist to choose the proper GFR equation.

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Acknowledgments

The scientific guarantor of this publication is Ulf Nyman. The authors of this manuscript declare relationships with the following companies: Ulf Nyman: Honorarium (financial) for lecturing on contrast media, GE Healthcare and Bracco; reimbursements for GE Healthcare distribute OmniVis in Nordic countries, a computer program to estimate GFR; reimbursement for Advisory Board, GE Healthcare meeting, 21-22 June 2012, Gressy, France. All other authors declare no relationships. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was not required because this is a review paper. Written informed consent was not required for this study because this is a review paper. Methodology: Review paper.

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  1. Department of Translational Medicine, Division of Medical Radiology, Skåne University Hospital, Malmö, Sweden

    Ulf Nyman

  2. R&D Centre Skåne, Skåne University Hospital, Lund, Sweden

    Jonas Björk

  3. Department of Occupational and Environmental Medicine, Lund University, Lund, Sweden

    Jonas Björk

  4. Department of Clinical Chemistry, Skåne University Hospital, Lund, Sweden

    Sten-Erik Bäck & Anders Grubb

  5. Department of Nephrology, Skåne University Hospital, Malmö, Sweden

    Gunnar Sterner

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  1. Ulf Nyman
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Correspondence to Ulf Nyman.

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Nyman, U., Björk, J., Bäck, SE. et al. Estimating GFR prior to contrast medium examinations—what the radiologist needs to know!. Eur Radiol 26, 425–435 (2016). https://doi.org/10.1007/s00330-015-3842-9

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