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Renal impairment significantly affects the morbidity and death rates of cirrhosis patients. The estimated glomerular filtration rate (eGFR) calculation techniques and equations are derived from studies that did not include cirrhosis patients. These equations are erroneous and unreliable due to sarcopenia in cirrhosis. Further, the precision of eGFR equations varies across different ethnic groups. Cystatin C (CysC) based eGFR is more reliable as compare to Creatinine based eGFR in cirrhotic patients as Cystatin C is unrelated to muscle volume and liver function but have fallacies in presence of cirrhosis. Measurement of GFR by Iohexol clearance (mGFR) is one of the gold standard methods of accurate determination of eGFR. Iohexol is stable, the procedure has low inter-laboratory variation and it is simple and affordable. There is very scare data on Iohexol GFR in cirrhosis and none in Indian population.
This was prospective observational study. Consecutive patients with cirrhosis, above 18 years of age, were included. Patient with severe renal dysfunction, requirement of dialysis and any malignancy, known allergy to Iohexol were excluded. Iohexol weight-based dosage was given and timed blood samples were taken to measure Iohexol clearance (measured GFR, mGFR ). Plasma Iohexol levels was measured by high performance liquid chromatography and Cystatin-C was measured by ELISA in plasma samples. And registered under CTRI/2021/03/031980
e-GFR equations are not accurate when compared with measured GFR in cirrhosis patients. Although they correlate with m-GFR, the correlation is relatively modest. We propose, based on the data, that 100.72 – (-0.8 x Urea(mg/dl) can be used for predicting m- GFR in patients with cirrhosis. Limitation of the study is the small sample size. This is an ICMR sponsored study and we will continue with a larger cohort of patients to validate our findings and to reach to a more accurate formula