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Comparison of 99mTc-DTPA and 51Cr-EDTA for glomerular filtration rate measurement with the continuous infusion method

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Abstract

Background

In late 2018, the production of 51Chromium-labelled ethylenediamine tetra-acetic acid (51Cr-EDTA), a validated and widely used radio-isotopic tracer for measuring glomerular filtration rate, was halted. Technetium-99m-diethylenetriaminepentaacetic acid (99mTc-DTPA) has been validated for GFR measurement with a single bolus injection, a procedure not suitable in patients with extracellular compartment hyperhydration. In such cases, a bolus followed by continuous infusion of the tracer is required. The aim of this study was to evaluate whether 99mTc-DTPA with the infusion protocol can replace 51Cr-EDTA for GFR measurement.

Methods

We conducted a prospective single centre study during February and March 2019. All patients referred for GFR measurement received both radiotracers simultaneously: 51Cr-EDTA and 99mTc-DTPA bolus and continuous infusion were administered concomitantly through the same intravenous route. Over four and a half hours, plasma and urine samples were collected to calculate urinary and plasma clearance.

Results

Twenty-two patients were included (mean age 63.4 ± 17.5 years; 68% men). Mean urinary clearance of 51Cr-EDTA and 99mTc-DTPA was 52.4 ± 22.5 mL/min and 52.8 ± 22.6 mL/min, respectively (p = 0.47), with a mean bias of 0.39 ± 2.50 mL/min, an accuracy within 10% of 100% (95% CI 100; 100) and a Pearson correlation coefficient of 0.994. Mean plasma clearance of 51Cr-EDTA and 99mTc-DTPA was 54.8 ± 20.9 mL/min and 54.4 ± 20.9 mL/min, respectively (p = 0.61), with a mean bias of − 0.43 ± 3.89 mL/min, an accuracy within 10% of 77% (95% CI 59; 91) and a Pearson correlation coefficient of 0.983.

Conclusions

Urinary and plasma clearance of 99mTc-DTPA can be used with the infusion protocol to measure GFR.

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Data availability

The data supporting the findings of this study may be shared by the authors upon reasonable request.

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Funding

There is no source of funding for this study.

Author information

Author notes

  1. Clara Balouzet and Arthur Michon-Colin contributed equally to this work.

Authors and Affiliations

  1. Radiopharmacie, Pharmacie, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France

    Clara Balouzet, Léa Dupont & Corinne Smadja

  2. Faculté de Médecine, Université Paris Cité, Paris, France

    Arthur Michon-Colin, Emmanuelle Vidal-Petiot, Stéphanie Baron, Hamza Ayari, Raphaël Cohen, Pascal Houillier, Martin Flamant & Marie Courbebaisse

  3. Explorations fonctionnelles rénales, Physiologie, Hôpital européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France

    Arthur Michon-Colin, Caroline Prot-Bertoye, Stéphanie Baron, Hamza Ayari, Raphaël Cohen, Pascal Houillier & Marie Courbebaisse

  4. Explorations fonctionnelles multidisciplinaires, Physiologie, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France

    Emmanuelle Vidal-Petiot & Martin Flamant

  5. Centre de Recherche sur l’Inflammation, Inserm U1149, Université Paris Cité, Paris, France

    Emmanuelle Vidal-Petiot & Martin Flamant

  6. Centre de Recherche des Cordeliers, INSERM U1138, Sorbonne Université, Université Paris Cité, Paris, France

    Caroline Prot-Bertoye, Stéphanie Baron & Pascal Houillier

  7. Néphrologie, AURA Paris Plaisance, Paris, France

    Hamza Ayari

Authors
  1. Clara Balouzet
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Corresponding author

Correspondence to Marie Courbebaisse.

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Conflict of interest

The results presented in this paper have not been published previously in whole or part except in abstract format. The authors have conflict of interest to declare related to this study. Dr. Balouzet reports non-financial support from Curium, outside the submitted work, Pr. Courbebaisse reports grants from Biohealth (Italy), and Advicenne (France), and personal fees from Alnylam (France), outside the submitted work.

Ethical approval

This study was classified as non-interventional by the DRCI (Délégation à la Recherche Clinique et à l’Innovation) of APHP (Assistance Publique—Hôpitaux de Paris).

Human and animal rights

The study was approved by our local Ethics Committee (CERAPHP.5, IRB registration #00011928), and for scientific use, all data were anonymized. Research was conducted in accordance with good clinical practices and the Declaration of Helsinki.

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All patients received oral and written information about the study before inclusion, and signed informed consent.

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Balouzet, C., Michon-Colin, A., Dupont, L. et al. Comparison of 99mTc-DTPA and 51Cr-EDTA for glomerular filtration rate measurement with the continuous infusion method. J Nephrol 36, 2457–2465 (2023). https://doi.org/10.1007/s40620-023-01612-0

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