• Charlotte Salmon Gandonnière, Julie Helms, Olivier Le Tilly, Isabelle Benz-de Bretagne, Anne Bretagnol, Laetitia Bodet-Contentin, Emmanuelle Mercier, Jean-Michel Halimi, Dalila Benzékri-Lefèvre, Ferhat Meziani, Chantal Barin-Le Guellec, Stephan Ehrmann, and Clinical Research in Intensive Care and Sepsis - TRIal Group for Global Evaluation and Research in SEPsis (CRICS-TriggerSep) Network.
• Médecine Intensive Réanimation, INSERM CIC 1415, CHRU de Tours, Tours, France.
• Crit. Care Med. 2019 Aug 1; 47 (8): e623-e629.

ObjectiveTo assess glomerular filtration rate in the early phase of acute circulatory failure by measuring iohexol plasma clearance.DesignInterventional prospective multicentric study.SettingThree French ICUs in tertiary teaching hospitals.PatientsPatients with acute circulatory failure within 12 hours after ICU admission.InterventionsIV administration of a nontoxic 5-mL dose of iohexol. Collection of nine arterial blood samples over 24 hours for iohexol plasma concentration measurements. Iohexol clearance calculation with a population pharmacokinetic model. Iohexol clearance was an estimation of the mean glomerular filtration rate over 24 hours.Measurements And Main ResultsAmong 99 included patients, we could calculate iohexol clearance for 85. The median iohexol clearance was 31 mL/min (interquartile range, 16-44). According to iohexol clearance, 41 patients (48%) had severe hypofiltration (clearance, < 30 mL/min), 29 (34%) had moderate hypofiltration, and 10 (12%) had mild hypofiltration (clearance, 30-60 and 60-90 mL/min, respectively). Four patients (5%) had normal glomerular filtration rate, and only one (1%) showed hyperfiltration (clearance, > 130 mL/min). Urinary creatinine clearance underestimated renal impairment in one patient out of two; the bias of iohexol clearance toward 24-hour urinary creatinine clearance over the same period was -18.1 mL/min (limits of agreement, -73.5 to 37.4).ConclusionsWe demonstrated the feasibility of iohexol clearance measurement in unstable critically ill patients. Normal kidney function is exceptional during the early phase of acute circulatory failure. Glomerular filtration rate estimation by urinary creatinine clearance frequently fails to detect renal impairment. Hyperfiltration is very infrequent.

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