Estimation of the Glomerular Filtration Rate in NIDDM Patients From Plasma Creatinine Concentration After Cimetidine Administration
- Frits AW Kemperman, MD,
- Joseph Silberbusch, MD, PHD,
- Eduard H Slaats, PHD,
- Ariël M Prins, PHD,
- Joop A Weber, PHD,
- Raymond T Krediet, MD, PHD and
- Lambertus Arisz, MD, PHD
- Department of Internal Medicine, Hospital Onze Lieve Vrouwe Gasthuis, University of Amsterdam The Netherlands
- Department of Clinical Chemistry, Hospital Onze Lieve Vrouwe Gasthuis, University of Amsterdam The Netherlands
- Department of Clinical Pharmacy and Radiopharmacy, Hospital Onze Lieve Vrouwe Gasthuis, University of Amsterdam The Netherlands
- Department of Clinical Chemistry, Academic Medical Centre, University of Amsterdam The Netherlands
- Department of Internal Medicine, Academic Medical Centre, University of Amsterdam The Netherlands
- Address correspondence and reprint requests to Frits A.W Kemperman, MD, Academic Medical Centre, University of Amsterdam, Department of Nephrology, F4-215, PO Box 22700, 1100 DE Amsterdam, The Netherlands. E-mail: m.a.zeeman{at}amc.uva.nl
Abstract
OBJECTIVE Glomerular filtration rate (GFR) can be estimated in patients with renal disease from plasma creatinine concentration, age, sex, and body weight according to the formula of Cockcroft and Gault. The hypothesis that this method can be improved when tubular secretion of creatinine is inhibited by cimetidine was studied in NIDDM patients.
RESEARCH DESIGN AND METHODS In 30 outpatients with NIDDM and normo-(n = 10), micro- (n = 9), or macroalbuminuria (n = 11), GFR was measured as the urinary clearance during continuous infusion of 125I-labeled iothalamate. Plasma creatinine concentration was analyzed with an enzymatic assay before and after 800 mg t.i.d. oral cimetidine was given during a 24-h period.
RESULTS Plasma creatinine rose in all patients after cimetidine administration and, as a consequence, the clearance calculated with the Cockcroft-Gault formula fell. The ratio of this formula and GFR decreased from 1.16 ± 0.20 to 0.97 ± 0.16 (means ± SD). This ratio tended to be smaller in the normo- (0.93) than in the micro- (0.98) and macroalbuminuric (1.00) groups. Also, 20 patients with a BMI < 30 kg/m2 had a smaller ratio than those with a BMI > 30 kg/m2 (0.92 vs. 1.07; P < 0.05). Bland and Altman analysis showed a difference of the Cockcroft-Gault formula and GFR of 12.0 ± 17.4 ml · min−1 · (1.73 m2)−1, which decreased to −3.8 ± 14.8 ml · min−1 · (1.73 m2)−1. The same analysis of 24-h creatinine clearance with urine collection and GFR showed larger standard deviations.
CONCLUSIONS GFR can be estimated in an acceptable way from plasma creatinine concentration after cimetidine administration in outpatients with NIDDM. Despite a nonsignificant underestimation in normoalbuminuric and overestimation in overweighted patients, this method is superior to 24-h creatinine clearance with outpatient urine collection.
- Received May 30, 1997.
- Revision received October 16, 1997.
- Accepted October 16, 1997.
- Copyright © 1998 by the American Diabetes Association
