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Hu L, Bai Y, Lai C, Mo L, Li Y, Jiang X, Xu W, He Y, Zhou X, Chen C. Plasma indole-3-aldehyde as a novel biomarker of acute kidney injury after cardiac surgery: a reanalysis using prospective metabolomic data. BMC Anesthesiol 2023; 23:364. [PMID: 37936070 PMCID: PMC10629179 DOI: 10.1186/s12871-023-02330-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 10/30/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is a frequent complication of cardiac surgery that poses significant risks for both the development of chronic kidney diseases and mortality. Our previous study illustrated that heightened expression levels of faecal and plasma indole metabolites before the operation were associated with ischemic AKI. In this study, we aimed to validate the supposition that plasma indole-3-aldehyde (I3A) could serve as a predictive biomarker for AKI in patients undergoing cardiac surgery. METHODS This statistical reanalysis utilized AKI metabolomic data from patients scheduled for cardiac surgery between April 2022 and July 2022 in two tertiary hospitals. Faecal and blood samples were prospectively collected before surgery within 24 h, and variables related to the preoperative, intraoperative, and postoperative periods were recorded. AKI diagnosis was based on the Kidney Disease Improving Global Outcomes criteria. RESULTS In this study, 55 patients who underwent cardiac surgery were analyzed, and 27 of them (49.1%) developed postoperative AKI. Before surgery, these patients had significantly higher levels of faecal indole metabolites, including skatole, trans-3-indoleacrylic acid, and 5-methoxyindoleacetic acid. The plasma I3A, clinical model that considered perioperative and intraoperative variables, and their combination had area under the receiver operating characteristic curve (ROC) values of 0.79 (95% CI 0.67-0.91), 0.78 (95% CI 0.66-0.90), and 0.84 (95% CI 0.74-0.94) for predicting AKI, respectively. Furthermore, by utilizing net reclassification improvement and integrated discrimination improvement, plasma I3A showed significant improvements in risk reclassification compared to the clinical model alone. CONCLUSIONS The dysregulation of gut microbiota metabolism in patients scheduled for cardiac surgery can result in an increase in indoles from tryptophan metabolism, which may be associated with postoperative acute kidney injury (AKI). This suggests that indoles may serve as a predictive biomarker for AKI in patients undergoing cardiac surgery.
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Affiliation(s)
- Linhui Hu
- Department of Critical Care Medicine, Maoming People's Hospital, No. 101 Weimin Road, Maoming, 525000, Guangdong Province, China
- Center of Scientific Research, Maoming People's Hospital, No. 101 Weimin Road, Maoming, 525000, Guangdong Province, China
| | - Yunpeng Bai
- Center of Scientific Research, Maoming People's Hospital, No. 101 Weimin Road, Maoming, 525000, Guangdong Province, China
| | - Changchun Lai
- Department of Clinical Laboratory, Maoming People's Hospital, No. 101 Weimin Road, Maoming, 525000, Guangdong Province, China
| | - Leitong Mo
- Department of Coronary Care Unit, Maoming People's Hospital, No. 101 Weimin Road, Maoming, 525000, Guangdong Province, China
| | - Ying Li
- Department of Intensive Care Unit of Cardiovascular Surgery, Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, No. 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong Province, China
| | - Xinyi Jiang
- Department of Intensive Care Unit of Cardiovascular Surgery, Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, No. 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong Province, China
- School of Medicine, South China University of Technology, No. 382 Waihuan East Road, Guangzhou, 510006, Guangdong Province, China
| | - Wang Xu
- Department of Intensive Care Unit of Cardiovascular Surgery, Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, No. 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong Province, China
- The Second School of Clinical Medicine, Southern Medical University, No. 1023 Shatai South Road, Guangzhou, 510515, Guangdong Province, China
| | - Yuemei He
- Center of Scientific Research, Maoming People's Hospital, No. 101 Weimin Road, Maoming, 525000, Guangdong Province, China
| | - Xinjuan Zhou
- Center of Scientific Research, Maoming People's Hospital, No. 101 Weimin Road, Maoming, 525000, Guangdong Province, China
| | - Chunbo Chen
- Department of Critical Care Medicine, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, China.
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Reina-Couto M, Afonso J, Carvalho J, Morgado L, Ronchi FA, de Oliveira Leite AP, Dias CC, Casarini DE, Bettencourt P, Albino-Teixeira A, Morato M, Sousa T. Interrelationship between renin-angiotensin-aldosterone system and oxidative stress in chronic heart failure patients with or without renal impairment. Biomed Pharmacother 2021; 133:110938. [DOI: 10.1016/j.biopha.2020.110938] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 10/18/2020] [Accepted: 10/24/2020] [Indexed: 12/22/2022] Open
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Wang F, Ding J. Pediatric Acute Kidney Injury to the Subsequent CKD Transition. KIDNEY DISEASES (BASEL, SWITZERLAND) 2021; 7:10-13. [PMID: 33614729 PMCID: PMC7879309 DOI: 10.1159/000509935] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 07/04/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Both acute kidney injury (AKI) and CKD are complex syndromes caused by multiple etiologies and presented with various degrees of severity. Studies on adults provide strong evidence that AKI is an independent risk factor for both the initiation and progression of CKD, and the severity, frequency, and duration of AKI are crucial factors in the subsequent development of CKD. However, without consensus definitions of AKI and CKD and long-term follow-up studies using predictive biomarkers, it is difficult to clarify the potential for transition from AKI to CKD in pediatric populations. The goal of this review is to describe the most recent studies in epidemiology of pediatric AKI and biomarkers aiding in the earlier detection of AKI and CKD. SUMMARY KDIGO criteria for AKI have been widely applied for pediatric AKI studies. AKI in critically ill and non-critically ill children is common. CKD is highly prevalent in pediatric AKI survivors. Compared with traditional biomarkers such as serum Cr, proteinuria, and estimated glomerular filtration rate, urinary biomarkers earlier identifying AKI may also detect CKD earlier, but additional studies are required to determine their clinical utility. KEY MESSAGES The use of consensus AKI criteria has improved our understanding of pediatric AKI epidemiology, and an association between AKI and CKD in pediatric populations has been endorsed. However, further studies are needed to better answer a definitive causal relationship between pediatric AKI and the subsequent development of CKD.
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Affiliation(s)
| | - Jie Ding
- Department of Pediatrics, Peking University First Hospital, Beijing, China
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Hashimoto A, Takeda Y, Karashima S, Kometani M, Aono D, Demura M, Higashitani T, Konishi S, Yoneda T, Takeda Y. Impact of mineralocorticoid receptor blockade with direct renin inhibition in angiotensin II-dependent hypertensive mice. Hypertens Res 2020; 43:1099-1104. [PMID: 32398797 DOI: 10.1038/s41440-020-0458-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 03/31/2020] [Accepted: 04/02/2020] [Indexed: 01/12/2023]
Abstract
It has been suggested that aldosterone breakthrough during treatment with a type 1 angiotensin II receptor (AT1R) blocker (ARB) may be an important risk factor for the progression of renal and cardiovascular disease. We examined whether the direct renin inhibitor, aliskiren caused aldosterone breakthrough in angiotensin II (Ang II)-dependent hypertensive mice. The effect of combination therapy with aliskiren and eplerenone was compared with that of therapy using renin-angiotensin system (RAS) blockade. Tsukuba hypertensive mice were treated for 12 weeks with aliskiren (30 mg/kg/day, i.p), candesartan (5 mg/kg/day, p.o), eplerenone (100 mg/kg/day, p.o) aliskiren and candesartan, aliskiren and eplerenone or candesartan and eplerenone. Blood pressure, urinary aldosterone and angiotensinogen (AGTN) excretion; plasma endothelin-1 concentration; kidney weight; urinary albumin excretion (UAE); glomerular injury; and renal messenger RNA (mRNA) levels for transforming growth factor (TGF)-β1, plasminogen activator inhibitor (PAI)-1, angiotensin-converting enzyme (ACE) and AT1R were measured. Combination therapy with aliskiren and candesartan caused a further decrease in blood pressure (p < 0.05) compared with either agent alone. Urinary aldosterone excretion was decreased significantly by 4 weeks of treatment with aliskiren or candesartan (p < 0.05). However, it was increased again by treatment with candesartan or aliskiren for 12 weeks. Combination therapy with aliskiren and eplerenone significantly decreased UAE, the glomerulosclerosis index, and PAI-1 and TGF-β1 mRNA levels compared with all other therapies (p < 0.05). Treatment with aliskiren decreased urinary aldosterone excretion at 4 weeks and increased it at 12 weeks. Combination therapy with a direct renin inhibitor and a mineralocorticoid receptor blocker may be effective for the prevention of renal injury in Ang II-dependent hypertension.
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Affiliation(s)
- Atsushi Hashimoto
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Yoshimichi Takeda
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | | | - Mitsuhiro Kometani
- Endocrinology and Metabolism, Kanazawa University Hospital, Kanazawa, Japan
| | - Daisuke Aono
- Endocrinology and Metabolism, Kanazawa University Hospital, Kanazawa, Japan
| | - Masashi Demura
- Department of Hygiene, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Takuya Higashitani
- Endocrinology and Metabolism, Kanazawa University Hospital, Kanazawa, Japan
| | - Seigo Konishi
- Endocrinology and Metabolism, Kanazawa University Hospital, Kanazawa, Japan
| | - Takashi Yoneda
- Institute of Liberal Arts and Science, Kanazawa University, Kanazawa, Japan
| | - Yoshiyu Takeda
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan. .,Innovative Clinical Research Center, Kanazawa University, Kanazawa, Japan.
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