RSS-Feed abonnieren
DOI: 10.1055/s-0038-1625739
Relationship between estimated glomerular filtration rate and biological half-life of 131I
Retrospective analysis in patients with differentiated thyroid carcinomaZusammenhang zwischen geschätzter glomerulärer Filtrationsrate und biologischer Halbwerts zeit von 131IRetrospektive Analyse bei Patienten mit differenziertem SchilddrüsenkarzinomPublikationsverlauf
received:
19. März 2013
accepted in revised form:
19. Juni 2013
Publikationsdatum:
12. Januar 2018 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00034924/201305/lookinside/thumbnails/10-1055s-0038-1625739_de-1.jpg)
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.
-
References
- 1 Alevizaki C, Molfetas M, Samartzis A. et al. Iodine 131 treatment for differentiated thyroid carcinoma in patients with end stage renal failure: dosimetric, radiation safety, and practical considerations. Hormones (Athens) 2006; 5: 276-287.
- 2 Andres A, Tardin L, Santapau A. et al. Treatment with 131I of thyroid remnants in a patient with papillary thyroid carcinoma and end-stage chronic renal failure. Rev Esp Med Nucl 2010; 29: 32-35.
- 3 Cavalieri RR. Iodine metabolism and thyroid physiology: current concepts. Thyroid 1997; 7: 177-181.
- 4 Coresh J, Selvin E, Stevens LA. et al. Prevalence of chronic kidney disease in the United States. JAMA. 2007; 298: 2038-2047.
- 5 Courbon F, Caselles O, Zerdoud S. et al. Iodine-131 pharmacokinetics in patients on hemodialysis for end stage renal disease: clinical implications. Q J Nucl Med Mol Imaging 2006; 50: 363-370.
- 6 Dietlein M, Dressler J, Eschner W. et al. Procedure guidelines for radioiodine therapy of differentiated thyroid cancer (version 3). Nuklearmedizin 2007; 46: 213-219.
- 7 Doogue MP, Polasek TM. Drug dosing in renal disease. Clin Biochem Rev 2011; 32: 69-73.
- 8 Hanscheid H, Lassmann M, Luster M. et al. Blood dosimetry from a single measurement of the whole body radioiodine retention in patients with differentiated thyroid carcinoma. Endocr Relat Cancer. 2009; 16: 1283-1289.
- 9 Hanscheid H, Lassmann M, Luster M. et al. Iodine biokinetics and dosimetry in radioiodine therapy of thyroid cancer: procedures and results of a prospective international controlled study of ablation after rhTSH or hormone withdrawal. J Nucl Med 2006; 47: 648-654.
- 10 Hartmann B, Czock D, Keller F. Drug therapy in patients with chronic renal failure. Dtsch Arztebl Int 2010; 107: 647-655.
- 11 Hartung-Knemeyer V, Nagarajah J, Jentzen W. et al. Pre-therapeutic blood dosimetry in patients with differentiated thyroid carcinoma using 124-iodine: predicted blood doses correlate with changes in blood cell counts after radioiodine therapy and depend on modes of TSH stimulation and number of preceding radioiodine therapies. Ann Nucl Med. 2012 doi:10.1007/s12149–012–0632–1.
- 12 Hassan Y, Al-Ramahi R, Abd Aziz N, Ghazali R. Drug use and dosing in chronic kidney disease. Ann Acad Med Singapore 2009; 38: 1095-1103.
- 13 Hindorf C, Glatting G, Chiesa C. et al. EANM Dosimetry Committee guidelines for bone marrow and whole-body dosimetry. Eur J Nucl Med Mol Imaging 2010; 37: 1238-1250.
- 14 Kaptein EM, Levenson H, Siegel ME. et al. Radioiodine dosimetry in patients with end-stage renal disease receiving continuous ambulatory peritoneal dialysis therapy. J Clin Endocrinol Metab 2000; 85: 3058-3064.
- 15 Lassmann M, Hanscheid H, Chiesa C. et al. EANM Dosimetry Committee series on standard operational procedures for pre-therapeutic dosimetry I: blood and bone marrow dosimetry in differentiated thyroid cancer therapy. Eur J Nucl Med Mol Imaging 2008; 35: 1405-1412.
- 16 Lassmann M, Reiners C, Luster M. Dosimetry and thyroid cancer: the individual dosage of radioiodine. Endocr Relat Cancer 2010; 17: R161-R172. doi:10.1677/ERC-10–0071.
- 17 Levey AS, Coresh J, Balk E. et al. National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med 2003; 139: 137-147.
- 18 Levey AS, Stevens LA, Schmid CH. et al. A new equation to estimate glomerular filtration rate. Ann Intern Med 2009; 150: 604-612.
- 19 Levey AS, Stevens LA. Estimating GFR using the CKD Epidemiology Collaboration (CKD-EPI) creatinine equation: more accurate GFR estimates, lower CKD prevalence estimates, and better risk predictions. Am J Kidney Dis 2010; 55: 622-627.
- 20 Luster M, Clarke SE, Dietlein M. et al. Guidelines for radioiodine therapy of differentiated thyroid cancer. Eur J Nucl Med Mol Imaging 2008; 35: 1941-1959.
- 21 Menzel C, Grünwald F, Schomburg A. et al. „Highdose“ radioiodine therapy in advanced differentiated thyroid carcinoma. J Nucl Med 1996; 37: 1496-1503.
- 22 Modarresifar H, Almodovar S, Bass WB, Ojha B. Radiation safety protocol for high dose 131I therapy of thyroid carcinoma in patients on hemodialysis for chronic renal failure. Health Phys 2007; 92 (Suppl. 02) S45-S49.
- 23 Pahlka RB, Sonnad JR. The effects of dialysis on 131I kinetics and dosimetry in thyroid cancer patients-- a pharmacokinetic model. Health Phys 2006; 91: 227-237.
- 24 Reiners C, Dietlein M, Luster M. Radio-iodine therapy in differentiated thyroid cancer: indications and procedures. Best Practice & Research Clinical Endocrinology & Metabolism. 2008; 22: 989-1007.
- 25 Rubino C, de Vathaire F, Dottorini ME. et al. Second primary malignancies in thyroid cancer patients. Br J Cancer 2003; 89: 1638-1644.
- 26 Saller B, Fink H, Mann K. Kinetics of acute and chronic iodine excess. Exp Clin Endocrinol Diabetes 1998; 106 (Suppl. 03) S34-S38.
- 27 Skali H, Uno H, Levey AS. et al. Prognostic assessment of estimated glomerular filtration rate by the new Chronic Kidney Disease Epidemiology Collaboration equation in comparison with the Modification of Diet in Renal Disease Study equation. Am Heart J 2011; 162: 548-554.
- 28 Stevens LA, Coresh J, Greene T, Levey AS. Assessing kidney function--measured and estimated glomerular filtration rate. N Engl J Med 2006; 354: 2473-2483. doi:10.1056/NEJMra054415.
- 29 Swedko PJ, Clark HD, Paramsothy K, Akbari A. Serum creatinine is an inadequate screening test for renal failure in elderly patients. Arch Intern Med 2003; 163: 356-360.
- 30 Tuttle RM, Leboeuf R, Robbins RJ. et al. Empiric radioactive iodine dosing regimens frequently exceed maximum tolerated activity levels in elderly patients with thyroid cancer. J Nucl Med 2006; 47: 1587-1591.
- 31 Willegaignon J, Ribeiro VP, Sapienza M. et al. Is it necessary to reduce the radioiodine dose in patients with thyroid cancer and renal failure?. Arq Bras Endocrinol Metabol 2010; 54: 413-418.