Glomerular filtration rate measured by iohexol clearance: A comparison of venous samples and capillary blood spots

Glomerular filtration rate (GFR) measured by iohexol clearance using venous samples is widely used. Capillary sampling on filter paper is easier to perform, may be less painful and spares the blood volume. The purpose of the study was to validate a blood spot method for measuring GFR in children aged 6 years or younger suffering from chronic kidney disease (CKD).

We examined 32 children with CKD, median age (range) 3.0 (0.3-6.2) years. Seven venous samples (10, 30/60, 120, 180, 210, 240, 300 min) were collected and GFR based on all samples was calculated for reference. Following injection of iohexol, blood spots were collected at 120, 180, 210 and 240 min and compared to the reference iohexol clearance.

Median (range) reference GFR was 65 (6-122) mL/min/1.73 m(2). The 2, 3 and 4-point blood spot GFR were highly correlated to the reference GFR (r = 0.947, 0.945, 0.937). The mean relative bias between 2-point blood spot and reference GFR was 7.2%, and only 2.3% in the patients with reference GFR < 60 mL/min/1.73 m(2). The diagnostic accuracy for 2-point blood spot was: 87.5% and 96.9% within ± 15% (P15) and ± 30% (P30) of the reference GFR respectively. In patients with GFR < 60 mL/min/1.73 m(2), both P15 and P30 were 100%.

GFR calculation based on blood spot iohexol measurement is an alternative method to traditional venous iohexol measurement in children. Our study demonstrates strong agreement between the blood spot and the venous GFR with acceptable bias, precision and diagnostic accuracy, especially in patients with GFR < 60 mL/min/1.73 m(2).