Marx MA, Shuler CL, Tattersall JE, Golper TA
Plasma iohexol clearance as an alternative to creatinine clearance for CAPD adequacy studies

Kidney Int (Dec) 48:1994-1997 1995

Because iohexol has a very low rate of non-renal excretion, the disappearance rate of iohexol from the plasma can be used as a method of measuring residual renal function, and in fact has been used for this purpose in dialysis patients. In this paper the authors are proposing using iohexol clearance as a means of assessing weekly creatinine clearance (residual renal plus dialytic removal) in CAPD patients. After a single injection of iohexol, two blood samples were obtained; the first 4-6 hours later, and the second 24 hours later. An automated X-ray fluorescence method of measuring plasma iohexol levels was used.

When iohexol clearance was compared against creatinine clearance by total dialysate collection for 24 hours, the r value was 0.80. There was substantial non-renal excretion, as the y-intercept was 30 liters/week (3 ml/min) per 1.73 m2 of GFR.

Comment: The authors propose this as a new method for following CAPD adequacy, but the relatively loose correlation with CCr, the substantial non- renal excretion, and the history of nephrotoxicity of radiocontrast media, coupled with the importance of maintaining residual renal function in dialysis patients, are all factors that will (in my opinion) delay wide acceptance of this methodology. (Daugirdas)

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Basic peritoneal dialysis : Chronic PD regimens, adequacy, modeling