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Siew ED, Hellwege JN, Hung AM, Birkelo BC, Vincz AJ, Parr SK, Denton J, Greevy RA, Robinson-Cohen C, Liu H, Susztak K, Matheny ME, Edwards DRV. Genome-wide association study of hospitalized patients and acute kidney injury. Kidney Int 2024:S0085-2538(24)00338-7. [PMID: 38797326 DOI: 10.1016/j.kint.2024.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 03/15/2024] [Accepted: 04/05/2024] [Indexed: 05/29/2024]
Abstract
Acute kidney injury (AKI) is a common and devastating complication of hospitalization. Here, we identified genetic loci associated with AKI in patients hospitalized between 2002-2019 in the Million Veteran Program and data from Vanderbilt University Medical Center's BioVU. AKI was defined as meeting a modified KDIGO Stage1 or more for two or more consecutive days or kidney replacement therapy. Control individuals were required to have one or more qualifying hospitalizations without AKI and no evidence of AKI during any other observed hospitalizations. Genome-wide association studies (GWAS), stratified by race, adjusting for sex, age, baseline estimated glomerular filtration rate (eGFR), and the top ten principal components of ancestry were conducted. Results were meta-analyzed using fixed effects models. In total, there were 54,488 patients with AKI and 138,051 non-AKI individuals included in the study. Two novel loci reached genome-wide significance in the meta-analysis: rs11642015 near the FTO locus on chromosome 16 (obesity traits) (odds ratio 1.07 (95% confidence interval, 1.05-1.09)) and rs4859682 near the SHROOM3 locus on chromosome 4 (glomerular filtration barrier integrity) (odds ratio 0.95 (95% confidence interval, 0.93-0.96)). These loci colocalized with previous studies of kidney function, and genetic correlation indicated significant shared genetic architecture between AKI and eGFR. Notably, the association at the FTO locus was attenuated after adjustment for BMI and diabetes, suggesting that this association may be partially driven by obesity. Both FTO and the SHROOM3 loci showed nominal evidence of replication from diagnostic-code-based summary statistics from UK Biobank, FinnGen, and Biobank Japan. Thus, our large GWA meta-analysis found two loci significantly associated with AKI suggesting genetics may explain some risk for AKI.
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Affiliation(s)
- E D Siew
- Tennessee Valley Health Systems, Nashville Veterans Affairs, Nashville, Tennessee, USA; Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Vanderbilt Center for Kidney Disease (VCKD) and Integrated Program for AKI Research (VIP-AKI), Nashville, Tennessee, USA.
| | - J N Hellwege
- Tennessee Valley Health Systems, Nashville Veterans Affairs, Nashville, Tennessee, USA; Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - A M Hung
- Tennessee Valley Health Systems, Nashville Veterans Affairs, Nashville, Tennessee, USA; Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Vanderbilt Center for Kidney Disease (VCKD) and Integrated Program for AKI Research (VIP-AKI), Nashville, Tennessee, USA
| | - B C Birkelo
- Tennessee Valley Health Systems, Nashville Veterans Affairs, Nashville, Tennessee, USA; Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Vanderbilt Center for Kidney Disease (VCKD) and Integrated Program for AKI Research (VIP-AKI), Nashville, Tennessee, USA
| | - A J Vincz
- Tennessee Valley Health Systems, Nashville Veterans Affairs, Nashville, Tennessee, USA; Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Vanderbilt Center for Kidney Disease (VCKD) and Integrated Program for AKI Research (VIP-AKI), Nashville, Tennessee, USA
| | - S K Parr
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Vanderbilt Center for Kidney Disease (VCKD) and Integrated Program for AKI Research (VIP-AKI), Nashville, Tennessee, USA
| | - J Denton
- Tennessee Valley Health Systems, Nashville Veterans Affairs, Nashville, Tennessee, USA
| | - R A Greevy
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - C Robinson-Cohen
- Tennessee Valley Health Systems, Nashville Veterans Affairs, Nashville, Tennessee, USA; Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Vanderbilt Center for Kidney Disease (VCKD) and Integrated Program for AKI Research (VIP-AKI), Nashville, Tennessee, USA
| | - H Liu
- Division of Renal Electrolyte and Hypertension, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA; Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - K Susztak
- Division of Renal Electrolyte and Hypertension, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA; Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - M E Matheny
- Tennessee Valley Health Systems, Nashville Veterans Affairs, Nashville, Tennessee, USA; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - D R Velez Edwards
- Tennessee Valley Health Systems, Nashville Veterans Affairs, Nashville, Tennessee, USA; Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Division of Quantitative Sciences, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Tsai PH, Wang JS, Shen CH. Validation of a Prediction Model for Acute Kidney Injury after Cardiac Surgery in a Retrospective Asian Cohort. J Clin Med 2024; 13:2740. [PMID: 38792279 PMCID: PMC11122164 DOI: 10.3390/jcm13102740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/09/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024] Open
Abstract
Background: The incidence of postoperative acute kidney injury (AKI) is relatively high in some Asian regions. The objective of this study was to examine the performance of an AKI prediction model developed based on data from a White-dominant population in a retrospective Asian cohort of patients undergoing cardiovascular surgery. Methods: We retrospectively identified 549 patients who underwent elective major cardiovascular surgery (coronary artery bypass graft, valve surgery, and aorta surgery), and excluded those who underwent a percutaneous cardiovascular procedure. Patients with a baseline estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 were also excluded. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) definition. Performance of the prediction model for AKI was expressed as area under the receiver operating characteristic curve (AUC). Results: The prediction model had a good predictive accuracy for postoperative AKI (all AUC > 0.92). The AUC of the prediction model in subgroups of age (<65 years and ≥65 years), sex (male and female), hypertension, and diabetes were all >0.85 (all p values < 0.001). Conclusions: The model could be used to predict postoperative AKI in Asian patients undergoing cardiovascular surgery with a baseline eGFR ≥ 60 mL/min/1.73 m2.
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Affiliation(s)
- Pei-Hsin Tsai
- Department of Anesthesiology, Taichung Veterans General Hospital, Taichung 407219, Taiwan;
| | - Jun-Sing Wang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407219, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402202, Taiwan
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Ching-Hui Shen
- Department of Anesthesiology, Taichung Veterans General Hospital, Taichung 407219, Taiwan;
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402202, Taiwan
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
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Kikano S, Breeyear J, Aka I, Edwards TL, Van Driest SL, Kannankeril PJ. Association between nitric oxide synthase 3 genetic variant and acute kidney injury following pediatric cardiac surgery. Am Heart J 2022; 254:57-65. [PMID: 35988586 PMCID: PMC10925835 DOI: 10.1016/j.ahj.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/10/2022] [Accepted: 08/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) complicates 30% to 50% of cardiac surgeries in pediatric patients. Genetic variants that affect renal blood flow and inflammation have been associated with AKI after cardiac surgery in diverse populations of adults but have not been studied in children. The objective of this study is to test the hypothesis that common candidate genetic variants are associated with AKI following pediatric cardiac surgery. METHODS This is a retrospective cohort study at a single tertiary referral children's hospital of 2,062 individual patients undergoing surgery for congenital heart disease from September 2007 to July 2020. Pre-specified variants in candidate genes (AGTR1, APOE, IL6, NOS3, and TNF) were chosen. AKI was defined using Kidney Disease: Improving Global Outcomes serum creatinine criteria in the first week following surgery. Outcomes were analyzed by univariate and multivariable analysis of demographic, clinical, and genetic factors. RESULTS The study population had median age of 6 (interquartile range [IQR], 1-53) months, 759 (37%) of whom met criteria for postoperative AKI. In unadjusted analyses of each genetic variant, only NOS3 (rs2070744) was associated with lower risk for AKI (OR 0.75, 95% CI 0.62-0.9, P = .002). In logistic regression analyses adjusting for body surface area, previously identified genetic syndrome, Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) score, cardiopulmonary bypass time, and nephrotoxic medication exposure, the NOS3 variant remained protective against AKI (OR 0.7, 95% CI 0.58-0.85, P<.001). CONCLUSIONS A common variant in NOS3 is associated with decreased incidence of AKI in children undergoing cardiac surgery. Further analysis of the genetic contributions to postoperative AKI may help identify individual risk in the pediatric population.
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Affiliation(s)
- Sandra Kikano
- Center for Pediatric Precision Medicine, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN.
| | - Joseph Breeyear
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Ida Aka
- Center for Pediatric Precision Medicine, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Todd L Edwards
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Sara L Van Driest
- Center for Pediatric Precision Medicine, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN; Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Prince J Kannankeril
- Center for Pediatric Precision Medicine, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
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Karan R, Kovačević-Kostić N, Kirćanski B, Čumić J, Terzić D, Milićević V, Velinović V, Velinović M, Obrenović-Kirćanski B. Morphogenetic dispositions for variability in acute kidney injury after cardiac surgery: Pilot study. Front Med (Lausanne) 2022; 9:943254. [PMID: 36186791 PMCID: PMC9523005 DOI: 10.3389/fmed.2022.943254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background The aim of our study was to evaluate the degree of genetic homozygosity in cardiac surgical patients with postoperative acute kidney injury (AKI), compared to the subgroup without postoperative AKI, as well as to evaluate antropomorpho-genetic variability in cardiac surgical patients with regard to the presence and severity degree of AKI. Materials and methods The prospective cohort study included an analysis of 138 eligible coronary artery disease (CAD) surgical patients that were screened consecutively. The tested group was divided into three subgroups according to RIFLE criteria: Subgroup NoAKI (N = 91), risk (N = 31), and injury (N = 16). All individuals were evaluated for the presence of 19 observable recessive human traits (ORHT) as a marker of chromosomal homozygosity and variability. Results Comparing subgroups NoAKI and risk, four ORHTs were significantly more frequent in the risk subgroup. Comparing subgroups NoAKI and injury, nine ORHTs were significantly more frequent in the injury subgroup; while comparing the injury subgroup and risk, five ORHTs were significantly more frequent in injury than in the risk subgroup. Results also showed a significant increase in the mean value of ORHTs for the injury subgroup compared to NoAKI subgroup (p = 0.039). Variability decreased proportionally to the increase in the severity of AKI (VNoAKI = 32.81%, VRisk = 30.92%, and VInjury = 28.62%). Conclusion Our findings pointed to the higher degree of recessive homozygosity and decreased variability in AKI patients vs. NoAKI individuals, thus presumably facilitating the development and severity degree expression of AKI in patients after cardiac surgery.
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Affiliation(s)
- Radmila Karan
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Department of Anesthesiology and Intensive Care at Clinic for Cardiac Surgery, Clinical Center of Serbia, Belgrade, Serbia
- *Correspondence: Radmila Karan,
| | - Natasa Kovačević-Kostić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Department of Anesthesiology and Intensive Care at Clinic for Cardiac Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Bratislav Kirćanski
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Pacemaker Center, Clinical Center of Serbia, Belgrade, Serbia
| | - Jelena Čumić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Department of Anesthesiology and Intensive Care at Clinic for Cardiac Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Duško Terzić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Department for Transplantation and LVAD at Clinic for Cardiac Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | | | | | - Miloš Velinović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Cardiac Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Biljana Obrenović-Kirćanski
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia
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Advances in pediatric acute kidney injury. Pediatr Res 2022; 91:44-55. [PMID: 33731820 DOI: 10.1038/s41390-021-01452-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 01/26/2021] [Accepted: 02/16/2021] [Indexed: 01/10/2023]
Abstract
The objective of this study was to inform the pediatric nephrologists of recent advances in acute kidney injury (AKI) epidemiology, pathophysiology, novel biomarkers, diagnostic tools, and management modalities. Studies were identified from PubMed, EMBASE, and Google Scholar for topics relevant to AKI. The bibliographies of relevant studies were also reviewed for potential articles. Pediatric (0-18 years) articles from 2000 to May 2020 in the English language were included. For epidemiological outcomes analysis, a meta-analysis on data regarding AKI incidence, mortality, and proportion of kidney replacement therapy was performed and an overall pooled estimate was calculated using the random-effects model. Other sections were created highlighting pathophysiology, novel biomarkers, changing definitions of AKI, evolving tools for AKI diagnosis, and various management modalities. AKI is a common condition seen in hospitalized children and the diagnosis and management have shown to be quite a challenge. However, new standardized definitions, advancements in diagnostic tools, and the development of novel management modalities have led to increased survival benefits in children with AKI. IMPACT: This review highlights the recent innovations in the field of AKI, especially in regard to epidemiology, pathophysiology, novel biomarkers, diagnostic tools, and management modalities.
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Ortega-Loubon C, Martínez-Paz P, García-Morán E, Tamayo-Velasco Á, López-Hernández FJ, Jorge-Monjas P, Tamayo E. Genetic Susceptibility to Acute Kidney Injury. J Clin Med 2021; 10:jcm10143039. [PMID: 34300206 PMCID: PMC8307812 DOI: 10.3390/jcm10143039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/02/2021] [Accepted: 07/03/2021] [Indexed: 12/14/2022] Open
Abstract
Acute kidney injury (AKI) is a widely held concern related to a substantial burden of morbidity, mortality and expenditure in the healthcare system. AKI is not a simple illness but a complex conglomeration of syndromes that often occurs as part of other syndromes in its wide clinical spectrum of the disease. Genetic factors have been suggested as potentially responsible for its susceptibility and severity. As there is no current cure nor an effective treatment other than generally accepted supportive measures and renal replacement therapy, updated knowledge of the genetic implications may serve as a strategic tactic to counteract its dire consequences. Further understanding of the genetics that predispose AKI may shed light on novel approaches for the prevention and treatment of this condition. This review attempts to address the role of key genes in the appearance and development of AKI, providing not only a comprehensive update of the intertwined process involved but also identifying specific markers that could serve as precise targets for further AKI therapies.
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Affiliation(s)
- Christian Ortega-Loubon
- BioCritic. Group for Biomedical Research in Critical Care Medicine, University of Valladolid, 47003 Valladolid, Spain; (C.O.-L.); (E.G.-M.); (Á.T.-V.); (F.J.L.-H.); (E.T.)
- Department of Cardiovascular Surgery, Hospital Clinic of Barcelona, 08036 Barcelona, Spain
| | - Pedro Martínez-Paz
- BioCritic. Group for Biomedical Research in Critical Care Medicine, University of Valladolid, 47003 Valladolid, Spain; (C.O.-L.); (E.G.-M.); (Á.T.-V.); (F.J.L.-H.); (E.T.)
- Department of Surgery, Faculty of Medicine, University of Valladolid, 47003 Valladolid, Spain
- Correspondence: (P.M.-P.); (P.J.-M.); Tel.: +34-9834200000 (P.M.-P.); +34-687978535 (P.J.-M)
| | - Emilio García-Morán
- BioCritic. Group for Biomedical Research in Critical Care Medicine, University of Valladolid, 47003 Valladolid, Spain; (C.O.-L.); (E.G.-M.); (Á.T.-V.); (F.J.L.-H.); (E.T.)
- Department of Cardiology, Clinical University Hospital of Valladolid, 47003 Valladolid, Spain
| | - Álvaro Tamayo-Velasco
- BioCritic. Group for Biomedical Research in Critical Care Medicine, University of Valladolid, 47003 Valladolid, Spain; (C.O.-L.); (E.G.-M.); (Á.T.-V.); (F.J.L.-H.); (E.T.)
- Department of Hematology and Hemotherapy, Clinical University Hospital of Valladolid, 47003 Valladolid, Spain
| | - Francisco J. López-Hernández
- BioCritic. Group for Biomedical Research in Critical Care Medicine, University of Valladolid, 47003 Valladolid, Spain; (C.O.-L.); (E.G.-M.); (Á.T.-V.); (F.J.L.-H.); (E.T.)
- Institute of Biomedical Research of Salamnca (IBSAL), University Hospital of Salamanca, 37007 Salamanca, Spain
- Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Departmental Building Campus Miguel de Unamuno, 37007 Salamanca, Spain
| | - Pablo Jorge-Monjas
- BioCritic. Group for Biomedical Research in Critical Care Medicine, University of Valladolid, 47003 Valladolid, Spain; (C.O.-L.); (E.G.-M.); (Á.T.-V.); (F.J.L.-H.); (E.T.)
- Department of Anesthesiology and Critical Care, Clinical University Hospital of Valladolid, Ramón y Cajal Ave, 47003 Valladolid, Spain
- Correspondence: (P.M.-P.); (P.J.-M.); Tel.: +34-9834200000 (P.M.-P.); +34-687978535 (P.J.-M)
| | - Eduardo Tamayo
- BioCritic. Group for Biomedical Research in Critical Care Medicine, University of Valladolid, 47003 Valladolid, Spain; (C.O.-L.); (E.G.-M.); (Á.T.-V.); (F.J.L.-H.); (E.T.)
- Department of Anesthesiology and Critical Care, Clinical University Hospital of Valladolid, Ramón y Cajal Ave, 47003 Valladolid, Spain
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Giani JF, Veiras LC, Shen JZY, Bernstein EA, Cao D, Okwan-Duodu D, Khan Z, Gonzalez-Villalobos RA, Bernstein KE. Novel roles of the renal angiotensin-converting enzyme. Mol Cell Endocrinol 2021; 529:111257. [PMID: 33781839 PMCID: PMC8127398 DOI: 10.1016/j.mce.2021.111257] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 02/03/2021] [Accepted: 03/20/2021] [Indexed: 12/14/2022]
Abstract
The observation that all components of the renin angiotensin system (RAS) are expressed in the kidney and the fact that intratubular angiotensin (Ang) II levels greatly exceed the plasma concentration suggest that the synthesis of renal Ang II occurs independently of the circulating RAS. One of the main components of this so-called intrarenal RAS is angiotensin-converting enzyme (ACE). Although the role of ACE in renal disease is demonstrated by the therapeutic effectiveness of ACE inhibitors in treating several conditions, the exact contribution of intrarenal versus systemic ACE in renal disease remains unknown. Using genetically modified mouse models, our group demonstrated that renal ACE plays a key role in the development of several forms of hypertension. Specifically, although ACE is expressed in different cell types within the kidney, its expression in renal proximal tubular cells is essential for the development of high blood pressure. Besides hypertension, ACE is involved in several other renal diseases such as diabetic kidney disease, or acute kidney injury even when blood pressure is normal. In addition, studies suggest that ACE might mediate at least part of its effect through mechanisms that are independent of the Ang I conversion into Ang II and involve other substrates such as N-acetyl-seryl-aspartyl-lysyl-proline (AcSDKP), Ang-(1-7), and bradykinin, among others. In this review, we summarize the recent advances in understanding the contribution of intrarenal ACE to different pathological conditions and provide insight into the many roles of ACE besides the well-known synthesis of Ang II.
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Affiliation(s)
- Jorge F Giani
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Luciana C Veiras
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Justin Z Y Shen
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ellen A Bernstein
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - DuoYao Cao
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Derick Okwan-Duodu
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Zakir Khan
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Kenneth E Bernstein
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Comprehensive Comparisons among Inotropic Agents on Mortality and Risk of Renal Dysfunction in Patients Who Underwent Cardiac Surgery: A Network Meta-Analysis of Randomized Controlled Trials. J Clin Med 2021; 10:jcm10051032. [PMID: 33802296 PMCID: PMC7959132 DOI: 10.3390/jcm10051032] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 02/23/2021] [Accepted: 02/26/2021] [Indexed: 02/07/2023] Open
Abstract
Several kinds of inotropes have been used in critically ill patients to improve hemodynamics and renal dysfunction after cardiac surgery; however, the treatment strategies for reducing mortality and increasing renal protection in patients who underwent cardiac surgery remain controversial. Therefore, we performed a comprehensive network meta-analysis to overcome the lack of head-to-head comparisons. A systematic database was searched up to 31 December 2020, for randomized controlled trials that compared different inotropes on mortality outcomes and renal protective effects after cardiac surgery. A total of 29 trials were included and a frequentist network meta-analysis was performed. Inconsistency analyses, publication bias, and subgroup analyses were also conducted. Compared with placebo, use of levosimendan significantly decreased the risks of mortality (odds ratio (OR): 0.74; 95% confidence interval (CI): 0.56–0.97) and risk of acute renal injury (OR: 0.61; 95% CI: 0.45–0.82), especially in low systolic function patients. Use of levosimendan also ranked the best treatment based on the P-score (90.1%), followed by placebo (64.5%), milrinone (49.6%), dopamine (49.5%), dobutamine (29.1%), and fenoldopam (17.0%). Taking all the available data into consideration, levosimendan was a safe renal-protective choice for the treatment of patients undergoing cardiac surgery, especially for those with low systolic function.
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Privratsky JR, Li YJ, Haynes C, Podgoreanu M, Mathew J, Shah SH, Stafford-Smith M. Apolipoprotein L1 (APOL1) Coding Variants Are Associated With Creatinine Rise After Cardiac Surgery. J Cardiothorac Vasc Anesth 2020; 34:3314-3320. [PMID: 32434723 DOI: 10.1053/j.jvca.2020.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 04/10/2020] [Accepted: 04/13/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Acute kidney injury (AKI) is a complication of cardiac surgery that is considerably more common in African Americans (1.5-fold). Although homozygous status for apolipoprotein L1 (APOL1) risk alleles is associated with chronic kidney disease in individuals of African ancestry, whether these coding variants confer AKI risk is unknown. The present study examined whether APOL1 homozygous risk allele status was associated with AKI in African Americans after cardiac surgery. DESIGN Retrospective analysis of a cohort. SETTING Single-center university hospital. PARTICIPANTS African American patients from the CATHeterization GENetics study cohort who underwent cardiac surgery with cardiopulmonary bypass. INTERVENTIONS Genotyping of APOL1 alleles. MEASUREMENTS AND MAIN RESULTS Data from 125 African American patients included 12 APOL1 risk (ie, homozygous for risk alleles) patients and 113 APOL1 control (ie, wildtype or heterozygous for risk alleles) patients. The primary outcome to reflect AKI was peak serum creatinine rise after surgery relative to the preoperative creatinine (%ΔCr). The secondary outcome was Kidney Disease: Improving Global Outcomes (KDIGO) AKI criteria. In the primary analysis, peak creatinine rise was higher in risk compared with control patients in both univariate (%ΔCr 69.1 v 29.6%; p = 0.005) and multivariate regression (%ΔCr 88.5 v 43.7%; p = 0.006) analyses. For the secondary outcome, a trend toward KDIGO AKI development was noted in APOL1 risk patients, but this was not statistically significant. CONCLUSIONS African American cardiac surgery patients homozygous for APOL1 chronic kidney disease risk variants averaged a more than 2-fold higher postoperative creatinine rise even after adjustment for other risk factors, suggesting these alleles also are independent risk factors for AKI.
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Affiliation(s)
- Jamie R Privratsky
- Department of Anesthesiology, Duke University Medical Center, Durham, NC.
| | - Yi-Ju Li
- Department of Anesthesiology, Duke University Medical Center, Durham, NC; Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC; Duke Molecular Physiology Institute, Duke University, Durham, NC
| | - Carol Haynes
- Department of Medicine, Duke University Medical Center, Durham, NC
| | - Mihai Podgoreanu
- Department of Anesthesiology, Duke University Medical Center, Durham, NC
| | - Joseph Mathew
- Department of Anesthesiology, Duke University Medical Center, Durham, NC
| | - Svati H Shah
- Duke Molecular Physiology Institute, Duke University, Durham, NC; Department of Medicine, Duke University Medical Center, Durham, NC
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10
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Saw KME, Ng RGR, Chan SP, Ang YH, Ti LK, Chew THS. Association of genetic polymorphisms with acute kidney injury after cardiac surgery in a Southeast Asian population. PLoS One 2019; 14:e0213997. [PMID: 30973904 PMCID: PMC6459593 DOI: 10.1371/journal.pone.0213997] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 03/05/2019] [Indexed: 12/25/2022] Open
Abstract
Introduction Genetic polymorphisms are important in explaining the wide interpatient variability that exists in the development of acute kidney injury (AKI) post cardiac surgery. We hypothesised that polymorphisms in 4 candidate genes, namely angiotensin-converting enzyme (ACE), apolipoprotein-E (ApoE), interleukin-6 (IL-6), and tumour necrosis factor-alpha (TNF-α) are associated with AKI. Methods 870 patients who underwent cardiac surgery in Singapore were analysed. All patients who fulfilled stage 1 KDIGO criteria and above were considered to have AKI. This was investigated against various demographic, clinical and genetic factors. Results Increased age, history of hypertension, anaemia and renal impairment remained important preoperative risk factors for AKI. Intraoperatively, longer cardiopulmonary bypass (CPB) time and the use of intra-aortic balloon pump (IABP) were shown to be associated with AKI. Among the genetic factors, ACE-D allele was associated with an increased risk of AKI while IL6-572C allele was associated with a decreased risk of AKI. Conclusion ACE-D allele was associated with the development of AKI similar to other studies. On the other hand, IL6-572C was shown to have a protective role against the development of AKI, contradictory to studies done in the Caucasian population. This contradictory effect of IL6-572C is a result of a complex interplay between the gene and population specific modulating factors. Our findings further underscored the necessity of taking into account population specific differences when developing prediction models for AKI.
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Affiliation(s)
- Kah Ming Eddy Saw
- Department of Anaesthesiology, Singapore General Hospital, Academia, Level 5, Singapore
| | - Rui Ge Roderica Ng
- Department of Anaesthesiology, Singapore General Hospital, Academia, Level 5, Singapore
| | - Siew Pang Chan
- Cardiovascular Research Institute, National University Health System, Singapore
- Department of Mathematics and Statistics, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Yi Hui Ang
- Department of Anaesthesia, National University Health System, Singapore
| | - Lian Kah Ti
- Department of Anaesthesia, National University Health System, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- * E-mail:
| | - Tsong Huey Sophia Chew
- Department of Anaesthesiology, Singapore General Hospital, Academia, Level 5, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Duke-NUS Medical School, Singapore
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11
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Vilander LM, Vaara ST, Kaunisto MA, Pettilä V, Study Group TF. Common Inflammation-Related Candidate Gene Variants and Acute Kidney Injury in 2647 Critically Ill Finnish Patients. J Clin Med 2019; 8:jcm8030342. [PMID: 30862128 PMCID: PMC6463106 DOI: 10.3390/jcm8030342] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 02/26/2019] [Accepted: 03/04/2019] [Indexed: 12/19/2022] Open
Abstract
Acute kidney injury (AKI) is a syndrome with high incidence among the critically ill. Because the clinical variables and currently used biomarkers have failed to predict the individual susceptibility to AKI, candidate gene variants for the trait have been studied. Studies about genetic predisposition to AKI have been mainly underpowered and of moderate quality. We report the association study of 27 genetic variants in a cohort of Finnish critically ill patients, focusing on the replication of associations detected with variants in genes related to inflammation, cell survival, or circulation. In this prospective, observational Finnish Acute Kidney Injury (FINNAKI) study, 2647 patients without chronic kidney disease were genotyped. We defined AKI according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria. We compared severe AKI (Stages 2 and 3, n = 625) to controls (Stage 0, n = 1582). For genotyping we used iPLEXTM Assay (Agena Bioscience). We performed the association analyses with PLINK software, using an additive genetic model in logistic regression. Despite the numerous, although contradictory, studies about association between polymorphisms rs1800629 in TNFA and rs1800896 in IL10 and AKI, we found no association (odds ratios 1.06 (95% CI 0.89–1.28, p = 0.51) and 0.92 (95% CI 0.80–1.05, p = 0.20), respectively). Adjusting for confounders did not change the results. To conclude, we could not confirm the associations reported in previous studies in a cohort of critically ill patients.
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Affiliation(s)
- Laura M Vilander
- Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine,University of Helsinki and Helsinki University Hospital, 00014 Helsinki, Finland.
| | - Suvi T Vaara
- Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine,University of Helsinki and Helsinki University Hospital, 00014 Helsinki, Finland.
| | - Mari A Kaunisto
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki,000014 Helsinki, Finland.
| | - Ville Pettilä
- Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine,University of Helsinki and Helsinki University Hospital, 00014 Helsinki, Finland.
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12
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Huff C, Mastropietro CW, Riley C, Byrnes J, Kwiatkowski DM, Ellis M, Schuette J, Justice L. Comprehensive Management Considerations of Select Noncardiac Organ Systems in the Cardiac Intensive Care Unit. World J Pediatr Congenit Heart Surg 2018; 9:685-695. [PMID: 30322370 DOI: 10.1177/2150135118779072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
As the acuity and complexity of pediatric patients with congenital cardiac disease have increased, there are many noncardiac issues that may be present in these patients. These noncardiac problems may affect clinical outcomes in the cardiac intensive care unit and must be recognized and managed. The Pediatric Cardiac Intensive Care Society sought to provide an expert review of some of the most common challenges of the respiratory, gastrointestinal, hematological, renal, and endocrine systems in pediatric cardiac patients. This review provides a brief overview of literature available and common practices.
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Affiliation(s)
- Christin Huff
- 1 The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Christopher W Mastropietro
- 2 Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | | | - Jonathan Byrnes
- 1 The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Misty Ellis
- 5 Department of Pediatric Critical Care, University of Louisville, Norton Children's Hospital, Louisville, KY, USA
| | | | - Lindsey Justice
- 1 The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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13
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Liu Y, Sheng B, Wang S, Lu F, Zhen J, Chen W. Dexmedetomidine prevents acute kidney injury after adult cardiac surgery: a meta-analysis of randomized controlled trials. BMC Anesthesiol 2018; 18:7. [PMID: 29334927 PMCID: PMC5769334 DOI: 10.1186/s12871-018-0472-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 01/04/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Dexmedetomidine has been shown to confer direct renoprotection by stabilizing the sympathetic system, exerting anti-inflammatory effects and attenuating ischemia/reperfusion (I/R) injury in preclinical studies. Results from clinical trials of dexmedetomidine on acute kidney injury (AKI) following adult cardiac surgery are controversial. METHODS We searched EMBASE, PubMed, and Cochrane CENTRAL databases for randomized controlled trials (RCTs) comparing the renal effect of dexmedetomidine versus placebo or other anesthetic drugs in adult patients undergoing cardiac surgery. The primary outcome was the incidence of AKI. The secondary outcomes were mechanical ventilation (MV) duration, intensive care unit (ICU) stay and hospital length of stay(LOS), and postoperative mortality (in-hospital or within 30 days). RESULTS Ten trials with a total of 1575 study patients were selected. Compared with controls, dexmedetomidine significantly reduced the incidence of postoperative AKI [68/788 vs 97/787; odds ratio(OR), 0.65; 95% confidence interval (CI), 0.45-0.92; P = 0.02; I2 = 0.0%], and there was no difference between groups in postoperative mortality (4/487 vs 11/483; OR, 0.43; 95% CI, 0.14-1.28; P = 0.13; I2 = 0.0%), MV duration [in days; n = 1229; weighted mean difference(WMD), -0.22; 95% CI, -2.04 to 1.70; P = 0.81], ICU stay (in days; n = 1363; WMD, -0.85; 95% CI, -2.14 to 0.45; P = 0.20), and hospital LOS (in days; n = 878; WMD, -0.24; 95% CI, -0.71 to 0.23; P = 0.32). CONCLUSIONS Perioperative administration of dexmedetomidine in adult patients undergoing cardiac surgery may reduce the incidence of postoperative AKI. Future trials are needed to determine the dose and timing of dexmedetomidine in improving outcomes, especially in patients with decreased baseline kidney function.
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Affiliation(s)
- Yang Liu
- Department of Intensive care unit, Beijing Shijitan Hospital, Capital Medical University, No. 10, Tieyi Road, Haidian District, Beijing, 100038, China
| | - Bo Sheng
- Department of Intensive care unit, Beijing Shijitan Hospital, Capital Medical University, No. 10, Tieyi Road, Haidian District, Beijing, 100038, China
| | - Suozhu Wang
- Department of Intensive care unit, Beijing Shijitan Hospital, Capital Medical University, No. 10, Tieyi Road, Haidian District, Beijing, 100038, China
| | - Feiping Lu
- Department of Intensive care unit, Beijing Shijitan Hospital, Capital Medical University, No. 10, Tieyi Road, Haidian District, Beijing, 100038, China
| | - Jie Zhen
- Department of Intensive care unit, Beijing Shijitan Hospital, Capital Medical University, No. 10, Tieyi Road, Haidian District, Beijing, 100038, China
| | - Wei Chen
- Department of Intensive care unit, Beijing Shijitan Hospital, Capital Medical University, No. 10, Tieyi Road, Haidian District, Beijing, 100038, China.
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14
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Larach DB, Engoren MC, Schmidt EM, Heung M. Genetic variants and acute kidney injury: A review of the literature. J Crit Care 2017; 44:203-211. [PMID: 29161666 DOI: 10.1016/j.jcrc.2017.11.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 11/11/2017] [Indexed: 12/25/2022]
Abstract
PURPOSE Limited data exists on potential genetic contributors to acute kidney injury. This review examines current knowledge of AKI genomics. MATERIALS AND METHODS 32 studies were selected from PubMed and GWAS Catalog queries for original data studies of human AKI genetics. Hand search of references identified 3 additional manuscripts. RESULTS 33 of 35 studies were hypothesis-driven investigations of candidate polymorphisms that either did not consistently replicate statistically significant findings, or obtained significant results only in few small-scale studies. Vote-counting meta-analysis of 9 variants examined in >1 candidate gene study showed ≥50% non-significant studies, with larger studies generally finding non-significant results. The remaining 2 studies were large-scale unbiased investigations: One examining 2,100 genes linked with cardiovascular, metabolic, and inflammatory syndromes identified BCL2, SERPINA4, and SIK3 variants, while a genome-wide association study (GWAS) identified variants in BBS9 and the GRM7|LMCD1-AS1 intergenic region. All studies had relatively small sample sizes (<2300 subjects). Study heterogeneity precluded candidate gene and GWA meta-analysis. CONCLUSIONS Most studies of AKI genetics involve hypothesis-driven (rather than hypothesis-generating) candidate gene investigations that have failed to identify contributory variants consistently. A limited number of unbiased, larger-scale studies have been carried out, but there remains a pressing need for additional GWA studies.
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Affiliation(s)
- Daniel B Larach
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI 48109, USA.
| | - Milo C Engoren
- Departments of Anesthesiology, Division of Critical Care Medicine, and Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Ellen M Schmidt
- Department of Biostatistics, University of Michigan, Ann Arbor, MI 48109, USA
| | - Michael Heung
- Department of Internal Medicine, Division of Nephrology, University of Michigan, Ann Arbor, MI 48109, USA
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15
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Abstract
Acute kidney injury (AKI) is a common complication in surgical patients and is associated with increases in mortality, an increased risk for chronic kidney disease and hemodialysis after discharge, and increased cost. Better understanding of the risk factors that contribute to perioperative AKI has led to improved AKI prediction and will eventually lead to improved prevention of AKI, mitigation of injury when AKI occurs, and enhanced recovery in patients who sustain AKI. The development of advanced clinical prediction scores for AKI, new imaging techniques, and novel biomarkers for early detection of AKI provides new tools toward these ends.
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16
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Kwiatkowski DM, Krawczeski CD. Acute kidney injury and fluid overload in infants and children after cardiac surgery. Pediatr Nephrol 2017; 32:1509-1517. [PMID: 28361230 DOI: 10.1007/s00467-017-3643-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 03/02/2017] [Accepted: 03/03/2017] [Indexed: 01/11/2023]
Abstract
Acute kidney injury is a common and serious complication after congenital heart surgery, particularly among infants. This comorbidity has been independently associated with adverse outcomes including an increase in mortality. Postoperative acute kidney injury has a complex pathophysiology with many risk factors, and therefore no single medication or therapy has been demonstrated to be effective for treatment or prevention. However, it has been established that the associated fluid overload is one of the major determinants of morbidity, particularly in infants after cardiac surgery. Therefore, in the absence of an intervention to prevent acute kidney injury, much of the effort to improve outcomes has focused on treating and preventing fluid overload. Early renal replacement therapy, often in the form of peritoneal dialysis, has been shown to be safe and beneficial in infants with oliguria after heart surgery. As understanding of the pathophysiology of acute kidney injury and the ability to confidently diagnose it earlier continues to evolve, it is likely that novel preventative and therapeutic interventions will be available in the future.
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Affiliation(s)
- David M Kwiatkowski
- Division of Pediatric Cardiology, Stanford University School of Medicine, 750 Welch Road, Suite 321, Palo Alto, CA, 94062, USA.
| | - Catherine D Krawczeski
- Division of Pediatric Cardiology, Stanford University School of Medicine, 750 Welch Road, Suite 321, Palo Alto, CA, 94062, USA
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17
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Abstract
Acute kidney injury (AKI) is characterized by an acute decline in renal function and is associated to increased mortality rate, hospitalization time, and total health-related costs. The severity of this ‘fearsome’ clinical complication might depend on, or even be worsened by, the late detection of AKI, when the diagnosis is based on the elevation of serum creatinine (SCr). For these reasons, in recent years a great number of new tools, biomarkers and predictive models have been proposed to clinicians in order to improve diagnosis and prevent the development of AKI. The purpose of this narrative paper is to review the current state of the art in prediction and early detection of AKI and outline future challenges.
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Affiliation(s)
- Simona Pozzoli
- Chair of Nephrology - IRCCS San Raffaele Scientific Institute, Genomics of Renal Diseases and Hypertension Unit, Università Vita Salute San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - Marco Simonini
- Chair of Nephrology - IRCCS San Raffaele Scientific Institute, Genomics of Renal Diseases and Hypertension Unit, Università Vita Salute San Raffaele, Via Olgettina 60, 20132, Milan, Italy.
| | - Paolo Manunta
- Chair of Nephrology - IRCCS San Raffaele Scientific Institute, Genomics of Renal Diseases and Hypertension Unit, Università Vita Salute San Raffaele, Via Olgettina 60, 20132, Milan, Italy
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18
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Abstract
AKI is an increasingly common disorder that is strongly linked to short- and long-term morbidity and mortality. Despite a growing heterogeneity in its causes, providing a timely and certain diagnosis of AKI remains challenging. In this review, we summarize the evolution of AKI biomarker studies over the past few years, focusing on two major areas of investigation: the early detection and prognosis of AKI. We highlight some of the lessons learned in conducting AKI biomarker studies, including ongoing attempts to address the limitations of creatinine as a reference standard and the recent shift toward evaluating the prognostic potential of these markers. Lastly, we suggest current gaps in knowledge and barriers that may be hindering their incorporation into care and a full ascertainment of their value.
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Affiliation(s)
- Rakesh Malhotra
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, California
| | - Edward D. Siew
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical center, Nashville, Tennessee
- Tennessee Valley Healthcare System, Veteran's Administration Medical Center, Veterans Health Administration, Nashville, Tennessee; and
- Vanderbilt Center for Kidney Disease and Integrated Program for Acute Kidney Injury Research, Nashville, Tennessee
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19
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Zhang Y, Zhang X, Chi D, Wang S, Wei H, Yu H, Li Q, Liu B. Remote Ischemic Preconditioning for Prevention of Acute Kidney Injury in Patients Undergoing On-Pump Cardiac Surgery: A Systematic Review and Meta-Analysis. Medicine (Baltimore) 2016; 95:e3465. [PMID: 27631199 PMCID: PMC5402542 DOI: 10.1097/md.0000000000003465] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Remote ischemic preconditioning (RIPC) may attenuate acute kidney injury (AKI). However, results of studies evaluating the effect of RIPC on AKI after cardiac surgery have been controversial and contradictory.The aim of this meta-analysis is to examine the association between RIPC and AKI after on-pump cardiac surgery.The authors searched relevant studies in PubMed, EMBASE, and the Cochrane Library through December 2015.We considered for inclusion all randomized controlled trials that the role of RIPC in reducing AKI and renal replacement therapy (RRT) among patients underwent on-pump cardiac surgical procedures.We collected the data on AKI, initiation of RRT, serum creatinine (sCr) levels, and in-hospital mortality. Random- and fixed-effect models were used for pooling data.Nineteen trials including 5100 patients were included. The results of this meta-analysis showed a significant benefit of RIPC for reducing the incidence of AKI after cardiac interventions (odds ratio [OR] = 0.84; 95% confidence interval [CI], 0.73-0.98; P = 0.02). No significant difference was found in the incidence of RRT between RIPC and control (OR, 0.76, 95% CI, 0.46-1.24; P = 0.36). In addition, compared with standard medical care, RIPC showed no significant difference in postoperative sCr (IV 0.07; 95% CI, -0.03 to 0.16; P = 0.20; postoperative day 1; IV 0.00; 95% CI, -0.08 to 0.09; P = 0.92; postoperative day 2; IV 0.04; 95% CI, -0.05 to 0.12; P = 0.39; postoperative day 3), and in-hospital mortality (OR, 1.21, 95% CI, 0.64-2.30; P = 0.56).According to the results from present meta-analysis, RIPC was associated with a significant reduction AKI after on-pump cardiac surgery but incidence of RRT, postoperative sCr, and in-hospital mortality. Further high-quality randomized controlled trials and experimental researches comparing RIPC are desirable.
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Affiliation(s)
- Yabing Zhang
- From the Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan (YZ, XZ, DC, SW, HY, QL, BL), and Department of Anesthesiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou (HW), China
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20
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Yates RB, Stafford-Smith M. The Genetic Determinants of Renal Impairment Following Cardiac Surgery. Semin Cardiothorac Vasc Anesth 2016; 10:314-26. [PMID: 17200089 DOI: 10.1177/1089253206294350] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Cardiac surgery is frequently performed, and acute renal dysfunction is a common adverse event following this procedure. Cardiac surgery-related renal injury independently predicts longer hospital stays and greater rates of morbidity and mortality. Although much work has been completed toward better understanding of this phenomenon, the state of knowledge concerning surgery-related renal injury remains limited. Currently, there is no effective paradigm to identify patients who are at risk for this condition; the specific mechanisms of renal injury during surgery are incompletely understood; and few therapies exist to prevent or treat this phenomenon. To better understand this common clinical problem, recent research has focused on the importance of genetic variability within the physiological and patho-physiological systems that underlie renal dysfunction following cardiac surgery. Emphasizing the importance of using genetics to elucidate molecular mechanisms of this disease, this article reviews the current literature on genetic polymorphisms and post cardiac surgery-related renal dysfunction.
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Affiliation(s)
- Robert B Yates
- Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA
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21
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Abstract
Just as the influence of genetic variation on patient outcomes is being discussed in many other areas of medicine, so too are its effects on cerebral outcome after cardiac surgery now being described. Whereas early studies focused on neurocognitive outcome, where the single nucleotide polymorphisms of APOE4 and PLA2 were the first investigated genetic targets, stroke is now being elaborated on with related single and multi-gene single nucleotide polymorphisms having been identified. Our work has established key links between post-cardiac surgery stroke and C-reactive protein (3’UTR 1846C/T) and interleukin-6 (-174 G/C) single nucleotide polymorphisms.
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Affiliation(s)
- Hilary P Grocott
- Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA.
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22
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Majumdar G, Barai S, Agarwal SK, Pande S, Chandra B, Tewari P. Can postoperative renal dysfunction be predicted by measuring intraoperative glomerular filtration rate in patients undergoing coronary artery bypass grafting without cardiopulmonary bypass? A pilot study. Indian J Thorac Cardiovasc Surg 2016. [DOI: 10.1007/s12055-016-0444-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Vilander LM, Kaunisto MA, Pettilä V. Genetic predisposition to acute kidney injury--a systematic review. BMC Nephrol 2015; 16:197. [PMID: 26627480 PMCID: PMC4667497 DOI: 10.1186/s12882-015-0190-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 11/24/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The risk of an individual to develop an acute kidney injury (AKI), or its severity, cannot be reliably predicted by common clinical risk factors. Whether genetic risk factors have an explanatory role poses an interesting question, however. Thus, we conducted a systematic literature review regarding genetic predisposition to AKI or outcome of AKI patients. METHODS We searched Ovid SP (MEDLINE) and EMBASE databases and found 4027 references to AKI. Based on titles and abstracts, we approved 37 articles for further analysis. Nine were published only as abstracts, leaving 28 original articles in the final analysis. We extracted the first author, year of publication, study design, clinical setting, number of studied patients, patients with AKI, ethnicity of patients, studied polymorphisms, endpoints, AKI definition, phenotype, significant findings, and data for quality scoring from each article. We summarized the findings and scored the quality of articles. RESULTS The articles were quite heterogeneous and of moderate quality (mean 6.4 of 10). CONCLUSIONS Despite different gene polymorphisms with suggested associations with development or severity or outcome of AKI, definitive conclusions would require replication of associations in independent cohort studies and, preferably a hypothesis-free study design.
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Affiliation(s)
- Laura M Vilander
- Intensive Care Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Mari A Kaunisto
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland. .,Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.
| | - Ville Pettilä
- Intensive Care Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
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Zhou C, Gong J, Chen D, Wang W, Liu M, Liu B. Levosimendan for Prevention of Acute Kidney Injury After Cardiac Surgery: A Meta-analysis of Randomized Controlled Trials. Am J Kidney Dis 2015; 67:408-16. [PMID: 26518388 DOI: 10.1053/j.ajkd.2015.09.015] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 09/03/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND Levosimendan has been shown to confer direct renoprotection in renal endotoxemic and ischemia-reperfusion injury and could increase renal blood flow in patients with low-cardiac-output heart failure. Results from clinical trials of levosimendan on acute kidney injury (AKI) following cardiac surgery are controversial. STUDY DESIGN A random-effect meta-analysis was conducted based on evidence from PubMed, EMBASE, and Cochrane Library. SETTINGS & POPULATION Adult patients undergoing cardiac surgery. SELECTION CRITERIA FOR STUDIES Randomized controlled trials comparing the renal effect of levosimendan versus placebo or other inotropic drugs during cardiac surgery. INTERVENTION Perioperative levosimendan continuous infusion at a rate of 0.1 to 0.2μg/kg/min following a loading dose (6-24μg/kg) for 24 hours or only 1 loading dose (24μg/kg) within 1 hour. OUTCOMES AKI, need for renal replacement therapy, mechanical ventilation duration, intensive care unit stay during hospitalization, and postoperative mortality (in-hospital or within 30 days). RESULTS 13 trials with a total of 1,345 study patients were selected. Compared with controls, levosimendan reduced the incidence of postoperative AKI (40/460 vs 78/499; OR, 0.51; 95% CI, 0.34-0.76; P=0.001; I(2)=0.0%), renal replacement therapy (22/492 vs 49/491; OR, 0.43; 95% CI, 0.25-0.76; P=0.002; I(2)=0.0%), postoperative mortality (35/658 vs 94/657; OR, 0.41; 95% CI, 0.27-0.62; P<0.001; I(2)=0.0%), mechanical ventilation duration (in days; n=235; weighted mean difference, -0.34; 95% CI, -0.58 to -0.09; P=0.007], and intensive care unit stay (in days; n=500; weighted mean difference, -2.2; 95% CI, -4.21 to -0.13; P=0.04). LIMITATIONS Different definitions for AKI among studies. Small sample size for some trials. CONCLUSIONS Perioperative administration of levosimendan in patients undergoing cardiac surgery may reduce complications. Future trials are needed to determine the dose effect of levosimendan in improving outcomes, especially in patients with decreased baseline kidney function.
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Affiliation(s)
- Chenghui Zhou
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Junsong Gong
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dong Chen
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weipeng Wang
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mingzheng Liu
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bin Liu
- Department of Anesthesiology, Laboratory of Anesthesia & Critical Care Medicine, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China.
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Bhatraju P, Hsu C, Mukherjee P, Glavan BJ, Burt A, Mikacenic C, Himmelfarb J, Wurfel M. Associations between single nucleotide polymorphisms in the FAS pathway and acute kidney injury. Crit Care 2015; 19:368. [PMID: 26477820 PMCID: PMC4610046 DOI: 10.1186/s13054-015-1084-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 09/27/2015] [Indexed: 11/10/2022] Open
Abstract
Introduction To determine whether single nucleotide polymorphisms (SNPs) in FAS and related genes are associated with acute kidney injury (AKI) in patients with acute respiratory distress syndrome (ARDS). Methods We studied 401 (Caucasian N = 310 and African-American N = 91) patients aged ≥ 13 years with ALI who enrolled in the Fluid and Catheter Treatment Trial (FACTT) between 2000 and 2005 from 20 North American centers. We genotyped 367 SNPs in 45 genes of the Fas/Fas ligand pathway to identify associations between SNPs in Fas pathway genes and the development of AKI by day 2 after enrollment in FACTT, adapting Acute Kidney Injury Network (AKIN) criteria. Written informed consent was obtained from participants or legally authorized surrogates in the original FACTT study and available to use for secondary analysis. Results In Caucasian patients, we identified associations between two SNPs and the incidence of AKI (stage 1 and above): rs1050851 and rs2233417; both are found within the gene for nuclear factor of kappa light polypeptide gene enhancer in B-cells inhibitor, alpha (NFKBIA). For rs1050851 and rs2233417, the odds ratios (ORs) were 2.34 (95 % confidence interval (CI) = 1.58–3.46, p = 1.06 × 10−5, FDR = 0.003) and 2.46 (CI = 1.61–3.76, p = 1.81 × 10−5, FDR = 0.003) for each minor allele, respectively. The associations were stronger still for AKIN stage 2–3 with respective ORs 4.00 (CI = 2.10–7.62, p = 1.05 × 10−5, FDR = 0.003) and 4.03 (CI = 2.09–7.77, p = 1.88 × 10−5, FDR = 0.003) for each minor allele homozygote. We observed no significant association between these SNPs and AKI in the smaller subset of African Americans. Conclusion In Caucasian patients with ALI, the presence of minor alleles in two SNPs in NFKBIA was strongly associated with the development of AKI. Trial registration NCT00281268. Registered 20/01/2006. Electronic supplementary material The online version of this article (doi:10.1186/s13054-015-1084-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pavan Bhatraju
- Pulmonary Critical Care Medicine, University of Washington, Harborview Medical Center, 325 Ninth Avenue, Box 359640, Seattle, WA, 98104, USA.
| | - Christine Hsu
- Kidney Research Institute, Division of Nephrology, University of Washington, Seattle, WA, USA.
| | - Paramita Mukherjee
- Kidney Research Institute, Division of Nephrology, University of Washington, Seattle, WA, USA.
| | - Bradford J Glavan
- Pulmonary Critical Care and Sleep Medicine, The Oregon Clinic, Portland, OR, USA.
| | - Amber Burt
- Biostatistics University of Washington, Seattle, WA, USA.
| | - Carmen Mikacenic
- Pulmonary and Critical Care, University of Washington, Seattle, WA, USA.
| | - Jonathan Himmelfarb
- Kidney Research Institute, Division of Nephrology, University of Washington, Seattle, WA, USA.
| | - Mark Wurfel
- Pulmonary and Critical Care, University of Washington, Seattle, WA, USA.
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Abstract
Perioperative acute kidney injury (AKI) is a common, morbid, and costly surgical complication. Current efforts to understand and manage AKI in surgical patients focus on prevention, mitigation of further injury when AKI has occurred, treatment of associated conditions, and facilitation of renal recovery. Lesser severity AKI is now understood to be much more common, and more morbid, than was previously thought. The ability to detect AKI within hours of onset would be helpful in protecting the kidney and in preserving renal function, and several imaging and biomarker modalities are currently being evaluated.
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Affiliation(s)
- Charles Hobson
- Department of Surgery, Malcom Randall VA Medical Center, NF/SG VAMC, Gainesville, FL 32608, USA; Department of Health Services Research, Management, and Policy, University of Florida, Gainesville, FL, USA
| | - Girish Singhania
- Department of Medicine, University of Florida, PO Box 100254, Gainesville, FL 32610-0254, USA
| | - Azra Bihorac
- Department of Medicine, University of Florida, PO Box 100254, Gainesville, FL 32610-0254, USA; Department of Anesthesiology, University of Florida, PO Box 100254, Gainesville, FL 32610-0254, USA.
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Lee-Son K, Jetton JG. AKI and Genetics: Evolving Concepts in the Genetics of Acute Kidney Injury: Implications for Pediatric AKI. J Pediatr Genet 2015; 5:61-8. [PMID: 27617143 DOI: 10.1055/s-0035-1557112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 05/21/2015] [Indexed: 12/21/2022]
Abstract
In spite of recent advances in the field of acute kidney injury (AKI) research, morbidity and mortality remain high for AKI sufferers. The study of genetic influences in AKI pathways is an evolving field with potential for improving outcomes through the identification of risk and protective factors at the individual level that may in turn allow for the development of rational therapeutic interventions. Studies of single nucleotide polymorphisms, individual susceptibility to nephrotoxic medications, and epigenetic factors comprise a growing body of research in this area. While promising, this field is still only emerging, with a small number of studies in humans and very little data in pediatric patients.
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Affiliation(s)
- Kathy Lee-Son
- Division of Pediatric Nephrology, Dialysis, and Transplantation, University of Iowa Children's Hospital, Iowa City, Iowa, United States
| | - Jennifer G Jetton
- Division of Pediatric Nephrology, Dialysis, and Transplantation, University of Iowa Children's Hospital, Iowa City, Iowa, United States
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Ebrahimi T, Pirasteh H, Rezakhaniha B, Dormanesh B, Rabati RG, Yahaghi E, Mokarizadeh A. RETRACTED ARTICLE: The value of U-NGAL expression as a potential prognostic biomarker in patients with renal cancer after neoadjuvant chemotherapy with cisplatin. Tumour Biol 2015; 37:10.1007/s13277-015-3680-z. [PMID: 26109001 DOI: 10.1007/s13277-015-3680-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Tahereh Ebrahimi
- Genetic and Agricultural Biotechnology, Institute of Tabarestan, Mazandaran, Iran
| | - Hamid Pirasteh
- Department of Nephrology, AJA University of Medical Sciences, Tehran, Iran
| | - Bijan Rezakhaniha
- Department of Urology, Imam Reza Hospital, AJA University of Medical Sciences, Tehran, Iran
| | - Banafshe Dormanesh
- Department of Pediatric Nephrology, AJA University of Medical Sciences, Tehran, Iran
| | | | - Emad Yahaghi
- Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Aram Mokarizadeh
- Cellular & Molecular Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran.
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Stafford-Smith M, Li YJ, Mathew JP, Li YW, Ji Y, Phillips-Bute BG, Milano CA, Newman MF, Kraus WE, Kertai MD, Shah SH, Podgoreanu MV. Genome-wide association study of acute kidney injury after coronary bypass graft surgery identifies susceptibility loci. Kidney Int 2015; 88:823-32. [PMID: 26083657 PMCID: PMC4589439 DOI: 10.1038/ki.2015.161] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 03/18/2015] [Accepted: 04/09/2015] [Indexed: 12/25/2022]
Abstract
Acute kidney injury (AKI) is a common, serious complication of cardiac surgery. Since prior studies have supported a genetic basis for postoperative AKI, we conducted a genome-wide association study (GWAS) for AKI following coronary bypass graft (CABG) surgery. The discovery dataset consisted of 873 non-emergent CABG surgery patients with cardiopulmonary bypass (PEGASUS), while a replication dataset had 380 cardiac surgical patients (CATHGEN). Single nucleotide polymorphism (SNP) data were based on Illumina Human610-Quad (PEGASUS) and OMNI1-Quad (CATHGEN) BeadChips. We used linear regression with adjustment for a clinical AKI risk score to test SNP associations with the postoperative peak rise relative to preoperative serum creatinine concentration as a quantitative AKI trait. Nine SNPs meeting significance in the discovery set were detected. The rs13317787 in GRM7|LMCD1-AS1 intergenic region (3p21.6) and rs10262995 in BBS9 (7p14.3) were replicated with significance in the CATHGEN data set and exhibited significantly strong overall association following meta-analysis. Additional fine-mapping using imputed SNPs across these two regions and meta-analysis found genome wide significance at the GRM7|LMCD1-AS1 locus and a significantly strong association at BBS9. Thus, through an unbiased GWAS approach, we found two new loci associated with post-CABG AKI providing new insights into the pathogenesis of perioperative AKI.
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Affiliation(s)
- Mark Stafford-Smith
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Yi-Ju Li
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina, USA.,Duke Molecular Physiology Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Joseph P Mathew
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Yen-Wei Li
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina, USA
| | - Yunqi Ji
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina, USA
| | | | - Carmelo A Milano
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Mark F Newman
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
| | - William E Kraus
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, North Carolina, USA.,Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Miklos D Kertai
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Svati H Shah
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, North Carolina, USA.,Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Mihai V Podgoreanu
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
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Stafford-Smith M. Acute kidney injury after cardiac and non-cardiac surgery: are there more similarities than differences? Can J Anaesth 2015; 62:727-30. [PMID: 25902892 DOI: 10.1007/s12630-015-0399-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 04/13/2015] [Indexed: 11/25/2022] Open
Affiliation(s)
- Mark Stafford-Smith
- Department of Anesthesiology, Duke University Medical Center, Box 3094 DUMC, Durham, NC, 27710, USA,
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Yang Y, Lang XB, Zhang P, Lv R, Wang YF, Chen JH. Remote Ischemic Preconditioning for Prevention of Acute Kidney Injury: A Meta-analysis of Randomized Controlled Trials. Am J Kidney Dis 2014; 64:574-83. [DOI: 10.1053/j.ajkd.2014.04.029] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 04/25/2014] [Indexed: 11/11/2022]
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Vaschetto R, Groeneveld ABJ. An update on acute kidney injury after cardiac surgery. Acta Clin Belg 2014; 62 Suppl 2:380-4. [PMID: 18284004 DOI: 10.1179/acb.2007.085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Renal dysfunction following cardiac surgery is well recognised and mainly is of ischaemic origin. The spectrum varies from subclinical injuryto established renal failure requiring renal replacement therapy. Depending on definitions, acute kidney injury (AKI) may occur in up to 30% of post cardiac surgery patients. A new grading system for renal dysfunction, based on three levels of plasma creatinine and urine output, as well as the use of biomarkers may help the early identification of patients at risk and thereby hopefully improve outcome. Despite therapeutic advances, the morbidity and mortality associated with AKI have not changed markedly in the last decade.
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Affiliation(s)
- R Vaschetto
- Department of Intensive Care Medicine, Vrije Universiteit Medical Centre, Amsterdam, The Netherlands
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Peacock WF, Maisel A, Kim J, Ronco C. Neutrophil gelatinase associated lipocalin in acute kidney injury. Postgrad Med 2014; 125:82-93. [PMID: 24200764 DOI: 10.3810/pgm.2013.11.2715] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Neutrophil gelatinase-associated lipocalin (NGAL) is a member of the lipocalin family of proteins. Usually, NGAL is produced and secreted by kidney tubule cells at low levels, but the amount produced and secreted into the urine and serum increases dramatically after ischemic, septic, or nephrotoxic injury of the kidneys. The purpose of our review article is to summarize the role of NGAL in acute kidney injury (AKI), emergent, and intensive care. METHODS A PubMed search was performed (only English-language articles concerning human subjects were considered) using each of the following search term combinations: neutrophil gelatinase-associated lipocalin OR NGAL and acute kidney injury OR AKI; cardiac surgery; heart failure OR cardiology; intensive care; emergency department OR emergency medicine; nephropathy OR nephrotoxicity and transplantation. RESULTS The results of our search yielded 339 articles. Of the 339 articles, 160 were eligible for review based on the predefined criteria for inclusion. CONCLUSION Based on the evidence reviewed, it is clear that patient NGAL level is an appropriate, sensitive, and specific early biomarker of AKI caused by a variety of different etiologies. It is advised that a multidisciplinary group of experts come together to make recommendations and propose a consensus of clinical procedures to advance the most efficacious NGAL monitoring protocol for early detection and treatment of patients with AKI.
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Affiliation(s)
- W Frank Peacock
- Baylor College of Medicine, Houston, TX; Ben Taub General Hospital, Houston, TX.
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Boehm J, Eichhorn S, Kornek M, Hauner K, Prinzing A, Grammer J, Lahm H, Wagenpfeil S, Lange R. Apolipoprotein E genotype, TNF-α 308G/A and risk for cardiac surgery associated-acute kidney injury in Caucasians. Ren Fail 2013; 36:237-43. [DOI: 10.3109/0886022x.2013.835267] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Cardinal-Fernández P, Ferruelo A, El-Assar M, Santiago C, Gómez-Gallego F, Martín-Pellicer A, Frutos-Vivar F, Peñuelas O, Nin N, Esteban A, Lorente JA. Genetic predisposition to acute kidney injury induced by severe sepsis. J Crit Care 2013; 28:365-70. [DOI: 10.1016/j.jcrc.2012.11.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 11/11/2012] [Accepted: 11/16/2012] [Indexed: 12/28/2022]
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Sodium Bicarbonate Infusion to Reduce Cardiac Surgery–Associated Acute Kidney Injury. Crit Care Med 2013; 41:1599-607. [DOI: 10.1097/ccm.0b013e31828a3f99] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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38
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Chew S, Mar W, Ti L. Association of ethnicity and acute kidney injury after cardiac surgery in a South East Asian population. Br J Anaesth 2013; 110:397-401. [DOI: 10.1093/bja/aes415] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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41
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McBride WT, Prasad PS, Armstrong M, Patterson C, Gilliland H, Drain A, Vuylsteke A, Latimer R, Khalil N, Evans A, Cambien F, Young I. Cytokine phenotype, genotype, and renal outcomes at cardiac surgery. Cytokine 2012; 61:275-84. [PMID: 23137784 DOI: 10.1016/j.cyto.2012.10.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 10/08/2012] [Accepted: 10/12/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cardiac surgery modulates pro- and anti-inflammatory cytokine balance involving plasma tumour necrosis factor alpha (TNFα) and interleukin-10 (IL-10) together with urinary transforming growth factor beta-1 (TGFβ1), interleukin-1 receptor antagonist (IL1ra) and tumour necrosis factor soluble receptor-2 (TNFsr2). Effects on post-operative renal function are unclear. We investigated if following cardiac surgery there is a relationship between cytokine (a) phenotype and renal outcome; (b) genotype and phenotype and (c) genotype and renal outcome. Since angiotensin-2 (AG2), modulates TGFβ1 production, we determined whether angiotensin converting enzyme insertion/deletion (ACE I/D) genotype affects urinary TGFβ1 phenotype as well as renal outcome. METHODS In 408 elective cardiac surgery patients we measured pre- and 24 h post-operative urinary TGFβ-1, IL1ra and TNFsr2 and pre- and 2 h post-operative plasma TNFα and IL-10. Post-operative responses were compared for each cytokine in patients grouped according to presence or absence of renal dysfunction defined as a drop from baseline eGFR of greater than 25% (as calculated by the method of modification of diet in renal disease (MDRD)) occurring (1) within the first 24 and (2) 48 postoperative hours (early renal dysfunction), (3) on the fifth postoperative day (late renal dysfunction) or (4) at any time throughout the 5 day postoperative period (early and late combined). Patient genotype was determined for TNF/G-308A, TGFβ1-509 C/T, IL10/G-1082A and ACE I/D. RESULTS Post-operative plasma IL-10 and urinary TGFβ1 responses were significantly higher in patients who developed early renal dysfunction. IL1ra and TNFsr2 responses were significantly lower 24h post-operatively in patients who developed late renal dysfunction. Genotype did not alter cytokine phenotype or outcome. CONCLUSIONS/INFERENCES: Cytokine profiling may help predict early and late renal dysfunction. Genotypes studied did not alter phenotype or outcome.
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Affiliation(s)
- William T McBride
- Department of Cardiac Anaesthesia, Belfast Health & Social Care Trust, Belfast BT12 6BA, Northern Ireland, UK.
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Perianayagam MC, Tighiouart H, Liangos O, Kouznetsov D, Wald R, Rao F, O'Connor DT, Jaber BL. Polymorphisms in the myeloperoxidase gene locus are associated with acute kidney injury-related outcomes. Kidney Int 2012; 82:909-19. [PMID: 22739978 PMCID: PMC3461107 DOI: 10.1038/ki.2012.235] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Myeloperoxidase (MPO) is a lysosomal enzyme that may be involved in oxidative stress-mediated kidney injury. Using a 2-step approach, we measured the association of 4 polymorphisms across the length of the MPO gene with systemic markers of oxidative stress; plasma MPO and urinary 15-F2t-isoprostane levels. Adverse outcomes were measured in a primary cohort of 262 adults hospitalized with acute kidney injury, and a secondary cohort of 277 adults undergoing cardiac surgery with cardiopulmonary bypass and at-risk for postoperative acute kidney injury. Dominant and haplotype multivariable logistic regression analyses found a genotype-phenotype association in the primary cohort between rs2243828, rs7208693, rs2071409, and rs2759 MPO polymorphisms and both markers of oxidative stress. In adjusted analyses, all 4 polymorphic allele groups had 2-3-fold higher odds for composite outcomes of dialysis or in-hospital death or a composite of dialysis, assisted mechanical ventilation or inhospital death. The MPO T-G-A-T haplotype copy-number was associated with lower plasma MPO levels and lower adjusted odds for the composite outcomes. Significant but less consistent associations were found in the secondary cohort. In summary, our 2-step genetic association study identified several polymorphisms spanning the entire MPO gene locus and a common haplotype marker for patients at-risk for acute kidney injury.
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Affiliation(s)
- Mary C Perianayagam
- Kidney and Dialysis Research Laboratory, Division of Nephrology, Department of Medicine, St Elizabeth's Medical Center, Tufts University School of Medicine, Boston, Massachusetts 02135, USA
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Prowle JR, Calzavacca P, Licari E, Ligabo EV, Echeverri JE, Haase M, Haase-Fielitz A, Bagshaw SM, Devarajan P, Bellomo R. Pilot double-blind, randomized controlled trial of short-term atorvastatin for prevention of acute kidney injury after cardiac surgery. Nephrology (Carlton) 2012; 17:215-24. [PMID: 22117606 DOI: 10.1111/j.1440-1797.2011.01546.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AIM To test whether short-term perioperative administration of oral atorvastatin could reduce incidence of postoperative acute kidney injury (AKI) in cardiac surgical patients. METHODS We conducted a double-blind, randomized controlled trial in 100 cardiac surgical patients at increased risk of postoperative AKI. Patients were randomized to atorvastatin (40 mg once daily for 4 days starting preoperatively) or identical placebo capsule. Primary outcome was to detect a smaller absolute rise in postoperative creatinine with statin therapy. Secondary outcomes included AKI defined by the creatinine criteria of RIFLE consensus classification (RIFLE R, I or F), change in urinary neutrophil gelatinase-associated lipocalin (NGAL) concentration, requirement for renal replacement therapy, length of stay in intensive care, length of stay in hospital and hospital mortality. RESULTS Study groups were well matched. For each patient maximal increase in creatinine during the 5 days after surgery was assessed; median maximal increase was 28 µmol/L in the atorvastatin group and 29.5 µmol/L in the placebo group (P = 0.62). RIFLE R or greater occurred in 26% of patients with atorvastatin and 32% with placebo (P = 0.65). Postoperatively urine NGAL changes were similar (median NGAL : creatinine ratio at intensive care unit admission: atorvastatin group 1503 ng/mg, placebo group 1101 ng/mg; P = 0.22). Treatment was well tolerated and adverse events were similar between groups. CONCLUSION Short-term perioperative atorvastatin use was not associated with a reduced incidence of postoperative AKI or smaller increases in urinary NGAL. (ClinicalTrials.gov NCT00910221).
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Affiliation(s)
- John R Prowle
- Department of Intensive Care, Austin Health, Melbourne, Victoria, Australia
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Cardinal-Fernández P, Ferruelo A, Martín-Pellicer A, Nin N, Esteban A, Lorente JA. [Genetic determinants of acute renal damage risk and prognosis: a systematic review]. Med Intensiva 2012; 36:626-33. [PMID: 22436318 DOI: 10.1016/j.medin.2012.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Revised: 01/31/2012] [Accepted: 02/02/2012] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Acute renal damage (ARD) is a frequent syndrome in hospitalized patients. It is well accepted that ARD susceptibility and outcome are related to environmental risk factors and to the patient premorbid status. Recently, host factors have also been recognized as important in ARD predisposition and evolution. OBJECTIVE To analyze genetic influences related to the risk and severity of ARD. DATA SOURCE MEDLINE search. SELECTION OF STUDIES articles published in English or Spanish between 1/1/1995 and 31/5/2011, analyzing the association between genic polymorphisms and (a) ARD susceptibility in patients versus healthy controls or within groups of patients; or (b) ARD severity. EXCLUSION CRITERIA studies published only in abstract form, case reports or including patients less than 16 years of age, on chronic dialysis or having received a renal transplant. DATA EXTRACTION at least one investigator analyzed each manuscript and collected the information using a predefined form. RESULTS We identified 12 relevant studies that included 4835 patients. Eleven genes showed polymorphisms related to ARD susceptibility or severity. They were related to cardiovascular regulation (ACE I/D, eNOS, FNMT and COMT), inflammatory response (TNFα, IL10, IL6, HIP-1α, EPO), oxidative stress (NAPH oxidase) and lipid metabolism (APO E). Only APO E, ACE and AT1 receptor have been analyzed in more than one study. CONCLUSION ARD susceptibility and severity is influenced by genetic factors, which are multiple and involve different physiopathological mechanisms.
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Affiliation(s)
- P Cardinal-Fernández
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, España.
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Perianayagam MC, Tighiouart H, Nievergelt CM, O'Connor DT, Liangos O, Jaber BL. CYBA Gene Polymorphisms and Adverse Outcomes in Acute Kidney Injury: A Prospective Cohort Study. NEPHRON EXTRA 2011; 1:112-23. [PMID: 22470385 PMCID: PMC3290849 DOI: 10.1159/000333017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND NADPH oxidase is an important enzyme involved in the generation of reactive oxygen species in acute kidney injury (AKI). Its key subunit, p22(phox), is encoded by the highly polymorphic CYBA gene. METHODS We examined the associations of CYBA gene polymorphisms across the CYBA locus (rs8854, rs3794624, rs4673, rs4782390, and rs1049255) with dialysis requirement or in-hospital death in 256 hospitalized adults with AKI. Dominant and haplotype multivariable logistic regression analyses were performed, adjusted for sex, race, age, and severity of illness. RESULTS The baseline characteristics of the patients were not different among genotype groups with the exception of a lower prevalence of sepsis and shock in the CYBA rs8854 A-allele group; a higher prevalence of shock in the CYBA rs4782390 T-allele group, and a higher APACHE II score in the CYBA rs1049255 G-allele group. The CYBA rs8854 A-allele had an adjusted odds ratio (OR) of 0.41 (95% confidence interval, CI, 0.18-0.96) for the outcome of dialysis requirement or in-hospital death. The CYBA rs4673 T-allele and rs1049255 G-allele had unadjusted ORs of 1.69 (95% CI 1.03-2.79) and 1.66 (95% CI 1.01-2.73) for the composite outcome, respectively, which became non-significant after multivariable adjustment. The remaining 2 polymorphisms were not associated with the outcomes of interest. Finally, the presence of the CYBA A-A-G-G haplotype (generated from rs4782390, rs4673, rs3794624, and rs8854, all in Hardy-Weinberg equilibrium) was associated with an elevated OR of 1.81 (95% CI 1.07-3.08) for dialysis requirement or in-hospital death, which was attenuated after multivariable adjustment (OR 1.80; 95% CI 0.99-3.29). CONCLUSION This study identifies several polymorphisms spanning the entire CYBA gene locus and a common haplotype as risk markers for dialysis requirement or in-hospital death in patients with AKI. Additional studies are needed to validate these findings.
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Affiliation(s)
- Mary C Perianayagam
- Department of Medicine, Division of Nephrology, Kidney and Dialysis Research Laboratory, St. Elizabeth's Medical Center, Boston, Mass
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Emiroglu O, Durdu S, Egin Y, Akar AR, Alakoc YD, Zaim C, Ozyurda U, Akar N. Thrombotic gene polymorphisms and postoperative outcome after coronary artery bypass graft surgery. J Cardiothorac Surg 2011; 6:120. [PMID: 21955693 PMCID: PMC3191480 DOI: 10.1186/1749-8090-6-120] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2011] [Accepted: 09/28/2011] [Indexed: 12/18/2022] Open
Abstract
Background Emerging perioperative genomics may influence the direction of risk assessment and surgical strategies in cardiac surgery. The aim of this study was to investigate whether single nucleotide polymorphisms (SNP) affect the clinical presentation and predispose to increased risk for postoperative adverse events in patients undergoing coronary artery bypass grafting surgery (CABG). Methods A total of 220 patients undergoing first-time CABG between January 2005 and May 2008 were screened for factor V gene G1691A (FVL), prothrombin/factor II G20210A (PT G20210A), angiotensin I-converting enzyme insertion/deletion (ACE-ins/del) polymorphisms by PCR and Real Time PCR. End points were defined as death, myocardial infarction, stroke, postoperative bleeding, respiratory and renal insufficiency and event-free survival. Patients were compared to assess for any independent association between genotypes for thrombosis and postoperative phenotypes. Results Among 220 patients, the prevalence of the heterozygous FVL mutation was 10.9% (n = 24), and 3.6% (n = 8) were heterozygous carriers of the PT G20210A mutation. Genotype distribution of ACE-ins/del was 16.6%, 51.9%, and 31.5% in genotypes I/I, I/D, and D/D, respectively. FVL and PT G20210A mutations were associated with higher prevalence of totally occluded coronary arteries (p < 0.001). Furthermore the risk of left ventricular aneurysm formation was significantly higher in FVL heterozygote group compared to FVL G1691G (p = 0.002). ACE D/D genotype was associated with hypertension (p = 0.004), peripheral vascular disease (p = 0.006), and previous myocardial infarction (p = 0.007). Conclusions FVL and PT G20210A genotypes had a higher prevalence of totally occluded vessels potentially as a result of atherothrombotic events. However, none of the genotypes investigated were independently associated with mortality.
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Affiliation(s)
- Ozan Emiroglu
- Department of Cardiovascular Surgery, Nicosia State Hospital, Nalbantoglu Lefkosa Devlet Hastanesi, Ortakoy, Nicosia, Cyprus.
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Haase M, Story DA, Haase-Fielitz A. Renal injury in the elderly: Diagnosis, biomarkers and prevention. Best Pract Res Clin Anaesthesiol 2011; 25:401-12. [DOI: 10.1016/j.bpa.2011.06.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Accepted: 06/16/2011] [Indexed: 12/27/2022]
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Chew S, Ti LIK. P-36 Association of ethnicity with acute kidney injury after cardiac surgery. J Cardiothorac Vasc Anesth 2011. [DOI: 10.1053/j.jvca.2011.03.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Popov AF, Schulz EG, Schmitto JD, Coskun KO, Tzvetkov MV, Kazmaier S, Zimmermann J, Schöndube FA, Quintel M, Hinz J. Relation between renal dysfunction requiring renal replacement therapy and promoter polymorphism of the erythropoietin gene in cardiac surgery. Artif Organs 2011; 34:961-8. [PMID: 21092038 DOI: 10.1111/j.1525-1594.2010.01108.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Several genetic polymorphisms have been identified to play a role in the occurrence and progression of renal dysfunction after cardiac surgery with cardiopulmonary bypass (CPB). Recently, it was demonstrated that the T allele of SNP rs1617640 in the promoter of the erythropoetin (EPO) gene is significantly associated with proliferative diabetic retinopathy (PDR) and end-stage renal disease (ESRD) due to increased EPO expression. This disease risk-associated gene and its potential pathway mediating severe microvascular complications in T-allele carriers could also play a role on renal dysfunction in patients who underwent cardiac surgery with CPB. We hypothesized that the patients' ability to produce increased EPO concentrations will affect morbidity and mortality after CPB. We conducted a prospective single center study between April 2006 and May 2007. In 481 patients who underwent cardiac surgery with CPB we prospectively examined the SNP rs1617640 in the promoter of the EPO gene by DNA sequencing. The patients were grouped according to their genotype (GG, GT, and TT). The genotype distribution of SNP rs1617640 in the promoter of the EPO gene was 36% (TT), 49% (TG), and 15% (GG). There was no difference in age, body mass index, gender, CPB time, or length of stay in intensive care unit. The hospitalization was irrespective of the patients' genotypes. The baseline creatinine in the TT group was 0.2 points higher than in the other groups; however this was without statistical significance in the multivariate analysis. No significant difference was shown in Euroscore, the Simplified Acute Physiology Score II, the Acute Physiology and Chronic Health Evaluation Score II, Acute Renal Failure Score, or the Risk, Injury, Failure, Loss of Kidney Function Score. The mortality was equal across the genotypes. However, an association between the TT genotype and acute renal replacement therapy (P=0.03), intra-aortic balloon pump usage (P=0.02), and serum creatine phosphokinase-MB increase (P=0.03) were observed after cardiac surgery. Our analysis suggests that the risk allele (T) of rs1617640 plays a role in the development of renal dysfunction after cardiac surgery with CPB. Patients with the TT risk allele required more frequent acute renal replacement therapy. Since our result is close to the border of significance, this hypothesis should be investigated in larger prospective studies with long-term follow-up to emphasize this polymorphism as a potential risk factor.
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Affiliation(s)
- Aron F Popov
- Department of Thoracic Cardiovascular Surgery, University of Göttingen, Germany.
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Dutkiewicz G, Domanski L, Binczak-Kuleta A, Pawlik A, Safranow K, Ciechanowicz A, Dziedziejko V, Ciechanowski K. The association between eNOS intron 4 VNTR polymorphism and delayed graft function of kidney allografts. Clin Transplant 2011; 24:E130-6. [PMID: 20047617 DOI: 10.1111/j.1399-0012.2009.01187.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Nitric oxide (NO) is a multifunctional agent which serves as a key signaling molecule in physiological processes such as host defense, neuronal communication, and the regulation of vascular tone. Different polymorphic variations have been identified in the human NOS3 (eNOS) gene.The aim of the present study was to examine the association between polymorphisms of the NOS3 gene (G894T substitution within exon 7 and intron 4 VNTR polymorphism) and the development of delayed graft function as well as acute and chronic rejection.One hundred eighty-seven recipients of first renal transplants were included in the study. There were no significant associations between these polymorphisms and acute and chronic kidney allograft rejection. The intron 4 polymorphism was associated with delayed graft function after transplantation. The results of this study suggest that patients with the a allele of the eNOS intron 4 VNTR polymorphism may be predisposed to delayed graft function.
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Affiliation(s)
- Grażyna Dutkiewicz
- Department of Nephrology, Transplantology, and Internal Medicine, Pomeranian Medical University, Szczecin, Poland
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