Relationship between estimated glomerular filtration rate and biological half-life of ¹³¹I

Summary

Aim: This retrospective study sought to investigate the relationship between biological half-life (t _{1/2 biol} ) of ¹³¹I and estimated glomerular filtration rate (eGFR) in patients with thyroid carcinoma. Patients, methods: 96 patients with differentiated thyroid carcinoma (69 women, 27 men, mean age 64.0 ± 13.6 years) and diagnostic and therapeutic administration of ¹³¹I were considered. Patients with pronounced specific iodine storage were not included in the study. The eGFR was estimated according to the Chronic Kidney Disease Epidemiology Collaboration (CKDEPI) formula, the t _{1/2 biol} via dosimetry. Patients were subdivided in groups with normal clearance (NC) (n = 37, 38.5%), medium clearance (MC) (n = 48, 50.0%), and low clearance (LC) (n = 11, 11.5%) (eGFR _ 90; 60-89; 15-59 ml/min per 1.73 m2, respectively). The relationship between eGFR and t _{1/2 biol} of ¹³¹I was modeled using a power function. Results: The groups significantly differed in terms of age (NC 53.8, MC 68.6, and 78.0 years, respectively), serum creatinine levels (NC: 0.71; MC: 0.85; LC: 1.18 mg/dl), and t _{1/2 biol} (NC: 0.53; MC: 0.71; LC: 1.01 days). The t _{1/2 biol} was significantly influenced only by eGFR, and not by age, gender, or body weight. The relationship between t _{1/2 biol} of ¹³¹I and eGFR was described by the formula t _{1/2 biol} = 20.3 · eGFR^−0.782. Conclusions: The calculated relationship between renal function and t _{1/2 biol} of ¹³¹I can be used in principle to estimate a dose reduction for patients with renal insufficiency. The model, however, gives erroneous results in individual cases and therefore a routine utilization cannot be recommended. Prospective studies are necessary, based on larger patient numbers and more accurate methods for dose rate measurement and GFR.

Zusammenfassung

Ziel dieser retrospektiven Studie war es, den Zusammenhang zwischen biologischer Halbwertszeit (t _{1/2 biol} ) von ¹³¹I und geschätzter glomerulärer Filtrationsrate (eGFR) bei Patienten mit differenziertem Schilddrüsenkarzinom zu ermitteln. Patienten und Methoden: Daten von 96 Patienten, die zur Behandlung eines differenzierten Schilddrüsenkarzinoms eine ¹³¹I-Gabe erhalten hatten, wurden ausgewertet (69 Frauen, 27 Männer, Durchschnittsalter 64.0 ± 13.6 Jahre). Die eGFR wurde mittels Chronic Kidney Disease Epidemiology (CKDEPI) Formel bestimmt und die t _{1/2 biol} von ¹³¹I aus Dosisleistungsmessungen ermittelt. Anhand der eGFR wurden eine Normal- (NC) (n = 37, 38,5%), eine Medium- (MC) (n = 48, 50%) und eine Low-Clearance-Gruppe (LC) (n = 11, 11,5%) gebildet (eGFR ≥ 90; 60–89; 15–59 ml/min per 1.73 m2). Der Zusammenhang zwischen eGFR und t _{1/2 biol} von ¹³¹I wurde mittels einer Potenzfunktion dargestellt. Ergebnisse: Es zeigten sich signifikante Gruppenunterschiede bezüglich Alter (NC: 53.8; MC: 68.6; LC: 78.0 Jahre), Serumkreatinin (NC: 0.71; MC: 0.85; LC: 1.18 mg/dl) und der t _{1/2 biol} (NC: 0.53; MC: 0.71; LC: 1.01 Tage). Ein signifikanter Einfluss auf die t _{1/2 biol} ließ sich nur für die eGFR, jedoch nicht für Alter, Geschlecht und Körpergewicht nachweisen. Der Zusammenhang zwischen t _{1/2 biol} von ¹³¹I und eGFR wurde mittels der Formel t _{1/2 biol} = 20.3 · eGFR^−0.782 dargestellt. Schlussfolgerung: Der Zusammenhang von Nierenfunktion und t _{1/2 biol} von ¹³¹I ist zwar grundsätzlich geeignet für die Abschätzung der Reduktion der zu applizierenden Aktivität. Da im Einzelfall jedoch große Fehlermöglichkeiten auftreten können, kann der ermittelte mathematische Zusammenhang nicht für den Routineeinsatz empfohlen werden. Prospektive Studien mit exakter Messung der Clearance und optimierten Dosisleistungsmessungen sind erforderlich.

Keywords

Renal insufficiency - Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) - thyroid cancer - radioiodine therapy - biological half-life - dose adaptation

Schlüsselwörter

Niereninsuffizienz - Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) - Schilddrüsenkarzinom - Radioiodtherapie - biologische Halbwertszeit - Aktivitätsanpassung

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