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Holthoff JH, Harville Y, Herzog C, Juncos LA, Karakala N, Arthur JM. SOD1 is a novel prognostic biomarker of acute kidney injury following cardiothoracic surgery. BMC Nephrol 2023; 24:299. [PMID: 37821813 PMCID: PMC10568797 DOI: 10.1186/s12882-023-03350-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/22/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is a major burden among hospitalized and critical care patients. Among hospitalized patients that progress to severe AKI there is increased risk for morbidity, mortality, and the need for renal replacement therapy (RRT). As there are no specific treatments for AKI, the discovery of novel biomarkers that predict the progression of AKI may aid in timely implementation of supportive care to improve outcomes. METHODS We collected urine from 204 patients that developed Stage 1 AKI by AKIN criteria within 72 h following cardiothoracic surgery. Urine samples were collected at the time of the initial diagnosis of AKI and stored at -80° C. Among the 204 patients, 25 progressed to a composite primary outcome of Stage 3 AKI, requirement of RRT, or 30-day mortality. The remaining 179 patients did not progress beyond Stage 2 AKI and were considered controls. Urinary concentrations of SOD1 and SOD1 activity were measured following collection of all samples. Samples were thawed and urinary superoxide dismutase 1 (SOD1) concentrations were measured by sandwich ELISA and urinary SOD1 activity was measured through a commercially available colorimetric assay. RESULTS Urinary concentrations of SOD1 were significantly elevated (67.0 ± 10.1 VS 880.3 ± 228.8 ng/ml, p < 0.0001) in patients that progressed to severe AKI and were able to predict the progression to severe AKI (AUC - 0.85, p < 0.0001). Furthermore, total SOD activity also increased in the urine of patients that required RRT (77.6% VS 49.81% median inhibition, p < 0.01) and was able to predict the need for RRT (AUC: 0.83, p < 0.01). CONCLUSION These findings show that urinary SOD1 concentrations and SOD activity are novel prognostic biomarkers for severe AKI following cardiothoracic surgery.
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Affiliation(s)
- Joseph H Holthoff
- Department of Nephrology, University of Arkansas for Medical Sciences, 4301 W. Markham St. #501, Little Rock, AR, 72205, USA.
- Division of Nephrology, Central Arkansas Veterans Healthcare System, Little Rock, AR, 72205, USA.
| | - Yanping Harville
- Department of Nephrology, University of Arkansas for Medical Sciences, 4301 W. Markham St. #501, Little Rock, AR, 72205, USA
| | - Christian Herzog
- Department of Nephrology, University of Arkansas for Medical Sciences, 4301 W. Markham St. #501, Little Rock, AR, 72205, USA
- Division of Nephrology, Central Arkansas Veterans Healthcare System, Little Rock, AR, 72205, USA
| | - Luis A Juncos
- Department of Nephrology, University of Arkansas for Medical Sciences, 4301 W. Markham St. #501, Little Rock, AR, 72205, USA
- Division of Nephrology, Central Arkansas Veterans Healthcare System, Little Rock, AR, 72205, USA
| | - Nithin Karakala
- Department of Nephrology, University of Arkansas for Medical Sciences, 4301 W. Markham St. #501, Little Rock, AR, 72205, USA
| | - John M Arthur
- Department of Nephrology, University of Arkansas for Medical Sciences, 4301 W. Markham St. #501, Little Rock, AR, 72205, USA
- Division of Nephrology, Central Arkansas Veterans Healthcare System, Little Rock, AR, 72205, USA
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Moriya R, Hokari S, Ohshima Y, Suzuki R, Nagai A, Fujito N, Takahashi A, Aoki N, Watanabe S, Koya T, Nakayama H, Izumizaki M, Kikuchi T. Continuous positive airway pressure treatment reduces renal tubular damage in patients with obstructive sleep apnea: A retrospective single-center cohort study. Sleep Med 2023; 106:106-115. [PMID: 37087824 DOI: 10.1016/j.sleep.2023.03.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/23/2023] [Accepted: 03/27/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Chronic intermittent hypoxia (IH) plays a significant role in the pathogenesis of obstructive sleep apnea (OSA) comorbidities. The prevalence of chronic kidney disease is higher in patients with OSA than the general population, and renal function decline is well correlated with renal tubular injury. However, little is known about the impact of OSA-induced chronic IH on the renal tubules. METHODS We conducted a retrospective survey of clinical records performing multiple regression analysis and cluster analysis with particular attention to the 3% oxygen desaturation index (ODI) and urinary N-acetyl-β-d-glucosaminidase (NAG). RESULTS In patients with suspicion of OSA, urinary NAG creatinine ratio (UNCR) was elevated as their 3% ODI increased (n = 197, p < 0.001), and the elevated UNCR decreased following CPAP treatment in patients with OSA (n = 46, p = 0.014). Multiple regression analysis showed that 3% ODI was associated with UNCR. Cluster analysis identified three clusters of patients with OSA, including two younger age clusters, one of which was characterized by high BMI, high 3% ODI, and high prevalence of major comorbidities. In a comparative analysis of younger age cases (age ≤ 55, n = 82), the UNCR level was higher in patients with severe 3% ODI (3% ODI > 40 events/h, n = 24) (p = 0.014). CONCLUSIONS Our results indicate that even at younger ages, OSA patients with severe chronic IH and major comorbidities are susceptible to renal tubular damage. Early treatment with CPAP may attenuate renal tubular injury and progression toward end-stage renal disease.
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Affiliation(s)
- Rika Moriya
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 951-8520, Japan; Department of Physiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
| | - Satoshi Hokari
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 951-8520, Japan.
| | - Yasuyoshi Ohshima
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 951-8520, Japan
| | - Ryoko Suzuki
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 951-8520, Japan
| | - Asuka Nagai
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 951-8520, Japan
| | - Nobuhiro Fujito
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 951-8520, Japan
| | - Atsunori Takahashi
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 951-8520, Japan
| | - Nobumasa Aoki
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 951-8520, Japan
| | - Satoshi Watanabe
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 951-8520, Japan
| | - Toshiyuki Koya
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 951-8520, Japan
| | - Hideaki Nakayama
- Department of Somnology, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Masahiko Izumizaki
- Department of Physiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
| | - Toshiaki Kikuchi
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 951-8520, Japan
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Hill A, Bergmann D, Schulte J, Zayat R, Marx G, Simon TP, Mossanen J, Brücken A, Stoppe C. Proenkephalin A and bioactive adrenomedullin are useful for risk prognostication in cardiac surgery. Front Cardiovasc Med 2023; 9:1017867. [PMID: 36756642 PMCID: PMC9900105 DOI: 10.3389/fcvm.2022.1017867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 12/28/2022] [Indexed: 01/24/2023] Open
Abstract
Introduction Various clinical scores have been developed to predict organ dysfunction and mortality in patients undergoing cardiac surgery, but outcome prediction may be inaccurate for some patient groups. Proenkephalin A (penKid) and bioactive adrenomedullin (bio-ADM) have emerged as promising biomarkers correlating with shock and organ dysfunction. This imposes the question of whether they can be used as prognostic biomarkers for risk stratification in the perioperative setting of cardiac surgery. Methods Patients undergoing cardiac surgery were prospectively enrolled in this observational study. PenKid and bio-ADM plasma levels, as well as markers evaluating inflammation and organ dysfunction, were measured at five perioperative time points from before the induction of anesthesia to up to 48 h postoperatively. Clinical data regarding organ dysfunction and patient outcomes were recorded during the intensive care unit (ICU)-stay with a special focus on acute kidney injury (AKI). Results In 136 patients undergoing cardiac surgery, the bio-ADM levels increased and the penKid levels decreased significantly over time. PenKid was associated with chronic kidney disease (CKD), the incidence of AKI, and renal replacement therapy (RRT). Bio-ADM was associated with lactate and the need for vasopressors. PenKid was useful to predict an ICU-length of stay (LOS)>1 day and added prognostic value to the European System for Cardiac Operative Risk Evaluation Score (EuroSCORE) II when measured after the end of cardiopulmonary bypass and 24 h after cardiac surgery. For bio-ADM, the same was true when measured 24 h after surgery. PenKid also added prognostic value to the EuroSCORE II for the combined outcome "ICU length of stay >1 day and in-hospital mortality." Conclusion The combination of preoperative EuroSCORE II and intraoperative measurement of penKid may be more useful to predict a prolonged ICU LOS and increased mortality than EuroSCORE II alone. Bio-ADM correlates with markers of shock. More research is encouraged for early risk stratification and validation of penKid and bio-ADM as a tool involved in clinical decisions, which may enable the early initiation of organ protective strategies.
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Affiliation(s)
- Aileen Hill
- Department of Intensive Care and Intermediate Care, Medical Faculty RWTH Aachen, Aachen, Germany
- Department of Anesthesiology, Medical Faculty RWTH Aachen, Aachen, Germany
| | | | | | - Rashad Zayat
- Department of Cardiothoracic Surgery, Medical Faculty RWTH Aachen, Aachen, Germany
| | - Gernot Marx
- Department of Intensive Care and Intermediate Care, Medical Faculty RWTH Aachen, Aachen, Germany
| | - Tim-Philipp Simon
- Department of Intensive Care and Intermediate Care, Medical Faculty RWTH Aachen, Aachen, Germany
| | - Jana Mossanen
- Department of Intensive Care and Intermediate Care, Medical Faculty RWTH Aachen, Aachen, Germany
| | - Anne Brücken
- Department of Intensive Care and Intermediate Care, Medical Faculty RWTH Aachen, Aachen, Germany
| | - Christian Stoppe
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, Germany
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Obiagwu PN, Morrow B, McCulloch M, Argent A. Burden and severity of deranged electrolytes and kidney function in children seen in a tertiary hospital in Kano, northern Nigeria. PLoS One 2023; 18:e0283220. [PMID: 36930619 PMCID: PMC10022757 DOI: 10.1371/journal.pone.0283220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 03/03/2023] [Indexed: 03/18/2023] Open
Abstract
INTRODUCTION Derangement in serum electrolytes and kidney function is often overlooked, especially in resource-constrained settings, and associated with increased risk of morbidity and mortality. This study aimed to describe the burden of derangements in serum electrolytes and kidney function in children presenting to a tertiary hospital in Nigeria. METHODS The laboratory records of all children who had serum electrolytes urea and creatinine ordered on their first presentation to hospital between January 1 and June 30, 2017 were retrospectively reviewed. Basic demographic data including admission status (inpatient or outpatient) were recordedandserum levels of sodium, potassium, chloride and bicarbonate were assessed for derangements usingnormal values from established reference ranges. Results of repeat samples were excluded. Kidney function was classified based on the serum creatinine relative to normal values for age and sex. RESULTS During the study period, 1909 children (60.3% male); median (IQR) age 42 (11.9) months had serum chemistry and 1248 (65.4%) were admitted. Results of their first samples were analyzed. Electrolyte derangements were present in 78.6% of the samples most commonly hyponatraemia (41.1%), low bicarbonate(37.2%), hypochloraemia (33.5%) and hypokalemia(18.9%). Azotaemia was found in 20.1% of the results. Elevated serum creatinine levels were found in 399 children (24.7%), 24.1% of those being in the severe category. Children aged 5 years and younger accounted for 76.4% of those with derangement in kidney function. One hundred and eight outpatients (17.8%) had deranged kidney function. CONCLUSION Deranged serum electrolytes and kidney function were common in this cohort.
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Affiliation(s)
- Patience N. Obiagwu
- Department of Paediatrics, Aminu Kano Teaching Hospital and Bayero University, Kano, Nigeria
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- * E-mail:
| | - Brenda Morrow
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Mignon McCulloch
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Andrew Argent
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Huang Y, Huang S, Zhuo X, Lin M. Predictive value of suPAR in AKI: a systematic review and meta-analysis. Clin Exp Nephrol 2023; 27:1-11. [PMID: 36469196 PMCID: PMC9734903 DOI: 10.1007/s10157-022-02300-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/18/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND Some clinical trials have shown that soluble urokinase-type plasminogen activator receptor (suPAR) has good predictive value for acute kidney injury (AKI), but there is still a lack of evidence-based proof. Therefore, we conducted this systematic review and meta-analysis to evaluate the predictive value of suPAR for AKI. METHODS Pubmed, EMBASE, Cochrane Library, and Web of Science databases were searched until December 2021 to obtain the literature on the prediction of suPAR for AKI. The quality of the included studies was assessed using the QUADAS-2 scoring system, and a bivariate random-effect model was used for the meta-analysis. The present study has been registered on PROSPERO (Registration No. CRD42022324978). RESULTS Seven articles were included, involving 2,319 patients, 635 of whom were AKI patients. The meta-analysis results showed that the combined sensitivity of suPAR in predicting AKI was 0.77 (95% CI 0.67-0.84); the specificity was 0.64 (95% CI 0.53-0.75); the odds ratio of diagnosis was 6 (95% CI 3-10); the pooled positive likelihood ratio was 2.2 (95% CI 1.6-2.9); the pooled negative likelihood ratio was 0.36 (95% CI 0.26-0.52); and the area under the summary receiver-operating characteristic (SROC) curve was 0.77 (95% CI 0.12~0.99). Deek's funnel plot suggested no potential publication bias among included studies. CONCLUSION suPAR is a valuable biomarker for the prediction of AKI with relatively high predictive accuracy, but its clinical application needs improvements. SuPAR should be considered as an indicator in the subsequent development of more effective predictive tools for AKI.
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Affiliation(s)
- Yan Huang
- Department of Clinical Laboratory, Foshan Hospital of Traditional Chinese Medicine, 6 Qinren Road, Chancheng District, Foshan City, 528000 Guangdong Province China
| | - Shengchun Huang
- Department of Clinical Laboratory, Foshan Hospital of Traditional Chinese Medicine, 6 Qinren Road, Chancheng District, Foshan City, 528000 Guangdong Province China
| | - Xueya Zhuo
- Department of Clinical Laboratory, Foshan Hospital of Traditional Chinese Medicine, 6 Qinren Road, Chancheng District, Foshan City, 528000 Guangdong Province China
| | - Mintao Lin
- Department of Clinical Laboratory, Foshan Hospital of Traditional Chinese Medicine, 6 Qinren Road, Chancheng District, Foshan City, 528000 Guangdong Province China
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Vagliano I, Chesnaye NC, Leopold JH, Jager KJ, Abu-Hanna A, Schut MC. Machine learning models for predicting acute kidney injury: a systematic review and critical appraisal. Clin Kidney J 2022; 15:2266-2280. [PMID: 36381375 PMCID: PMC9664575 DOI: 10.1093/ckj/sfac181] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND The number of studies applying machine learning (ML) to predict acute kidney injury (AKI) has grown steadily over the past decade. We assess and critically appraise the state of the art in ML models for AKI prediction, considering performance, methodological soundness, and applicability. METHODS We searched PubMed and ArXiv, extracted data, and critically appraised studies based on the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis (TRIPOD), Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS), and Prediction Model Risk of Bias Assessment Tool (PROBAST) guidelines. RESULTS Forty-six studies from 3166 titles were included. Thirty-eight studies developed a model, five developed and externally validated one, and three studies externally validated one. Flexible ML methods were used more often than deep learning, although the latter was common with temporal variables and text as predictors. Predictive performance showed an area under receiver operating curves ranging from 0.49 to 0.99. Our critical appraisal identified a high risk of bias in 39 studies. Some studies lacked internal validation, whereas external validation and interpretability of results were rarely considered. Fifteen studies focused on AKI prediction in the intensive care setting, and the US-derived Medical Information Mart for Intensive Care (MIMIC) data set was commonly used. Reproducibility was limited as data and code were usually unavailable. CONCLUSIONS Flexible ML methods are popular for the prediction of AKI, although more complex models based on deep learning are emerging. Our critical appraisal identified a high risk of bias in most models: Studies should use calibration measures and external validation more often, improve model interpretability, and share data and code to improve reproducibility.
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Affiliation(s)
- Iacopo Vagliano
- Deptartment of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Nicholas C Chesnaye
- ERA Registry, Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Jan Hendrik Leopold
- Deptartment of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Kitty J Jager
- ERA Registry, Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Ameen Abu-Hanna
- Deptartment of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Martijn C Schut
- Deptartment of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Zhou C, Chen Y, He X, Xue D. The value of cystatin C in predicting perioperative and long-term prognosis of renal transplantation. Scand J Clin Lab Invest 2022; 82:1-5. [PMID: 35012404 DOI: 10.1080/00365513.2021.1989714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study aimed to evaluate the value of cystatin C (Cys C) in predicting the perioperative and long-term prognosis of renal transplantation (RT). The clinical data of 198 RT recipients were collected. Blood samples were obtained daily until 7 d after transplantation and then discharge day to determine the serum levels of Cys C. The receiver-operating characteristic (ROC) analysis and the area under the curve (AUC) were used to determine the diagnostic accuracy of Cys C for delayed graft function (DGF). The presence of shrunken pore syndrome (SPS) with a cystatin C-based estimate of glomerular filtration rate less than 70% of a creatinine-based estimate, was also evaluated as a prognostic factor for the development of DGF. The serum Cys C levels of patients with DGF were higher than those of the non-DGF group. Cys C showed a higher AUC (0.928) in the ROC analysis than did sCr (0.862). Compared to the non-SPS group, there were more patients diagnosed with SPS in the DGF group (p < .05). The follow-up data showed that patients diagnosed with SPS had higher levels of sCr and Cys C compared to other patients, suggesting a poor long-term prognosis. Our findings suggest that Cys C is a sensitive indicator of renal function during the perioperative period. Cys C at a concentration of 4.9 mg/L had the highest sum of sensitivity and specificity for prediction of DGF, with a sensitivity of 0.889 and a specificity of 0.8. SPS is associated with the development of DGF and the poor long-term prognosis of RT.
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Affiliation(s)
- Cuixing Zhou
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Yimeng Chen
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Xiaozhou He
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Dong Xue
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
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Neutrophil gelatinase-associated lipocalin as a biomarker for predicting acute kidney injury after coronary artery bypass grafting. AIN-SHAMS JOURNAL OF ANESTHESIOLOGY 2021. [PMCID: PMC7816152 DOI: 10.1186/s42077-020-00123-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background Early and precocious determination of acute kidney injury (AKI) is essential to prevent morbidity and mortality following coronary artery bypass grafting (CABG). Evaluation of the perioperative renal function is substantial using novel biomarkers other than the late traditional method of using serum creatinine. Plasma neutrophil gelatinase-associated lipocalin (NGAL) is a biomarker investigated for early detection of AKI in patients undergoing coronary artery bypass grafting, and its role has to be determined in this study. Results Twenty-five patients undergoing elective CABG were enrolled in this cohort study and were assigned into two groups: group I include the patients that did not develop AKI (no AKI group) and group II include the patients that developed AKI (AKI group). Acute kidney injury based on Kidney Disease: Improving Global Outcomes (KDIGO) classification had been developed in 7 patients (28%). Plasma NGAL levels at 6 h were higher in patients who developed AKI compared with those who did not (302 ± 88.02 vs. 116.50 ± 17.33 ng/m, p value < 0.001). The cut-off value of plasma NGAL levels measured 6 h postoperatively was 145 ng/ml and the area under the receiver-operating characteristic (ROC) curve was 0.965. Results of this study showed that plasma NGAL is a robust early biomarker of AKI, which preceded the rise in serum creatinine by many hours. Conclusion This study revealed that earlier diagnosis of acute kidney injury in patients undergoing CABG can be achieved by measuring postoperative plasma NGAL concentration at 6 h.
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Gambaro A, Lombardi G, Onorati F, Gottin L, Ribichini FL. Heart, kidney and left ventricular assist device: a complex trio. Eur J Clin Invest 2021; 51:e13662. [PMID: 34347897 DOI: 10.1111/eci.13662] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/24/2021] [Accepted: 08/03/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Heart failure (HF) is a complex syndrome affecting the whole body, kidneys included. The left ventricular assist device (LVAD) is a valid option for patients with very severe HF. Focusing on renal function, LVAD implantation could theoretically reverse the detrimental effects of HF syndrome on kidneys. However, implanting an LVAD is a high-risk surgical procedure, and LVAD patients have higher risk of bleeding, device thrombosis, strokes, renal impairment, multi-organ failure and infections. Furthermore, an LVAD has its own particular effects on the renal system. METHODS In this review, we provide a comprehensive overview of the complex interaction between LVAD and the kidneys from the pathophysiological and clinical perspectives. An analysis of the different effects of pulsatile-flow and continuous-flow LVAD is provided. RESULTS Despite their limitations, creatinine-based estimated glomerular filtration rate (eGFR) formulas help to stratify patients by their post-LVAD placement prognosis. Poor basal renal function, the onset of acute kidney injury or the need for renal replacement therapy after LVAD implantation negatively influences a patient's prognosis. LVAD can also prompt an improvement in renal function, however, with some counterintuitive effects on a patient's prognosis. CONCLUSION It is still hard to say whether different trends in eGFR depend on different renal conditions before LVAD placement, on a patient's better overall status or on a particular patient management strategy before and/or after the device's implantation. Steps should be taken to solve this question because finding the best candidates for LVAD implantation is of paramount importance to ensure the best outcomes.
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Affiliation(s)
- Alessia Gambaro
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Gianmarco Lombardi
- Division of Nephrology, Department of Medicine, University of Verona, Verona, Italy
| | | | - Leonardo Gottin
- Unit of Cardiothoracic Anesthesia and Intensive Care, Department of Emergencies and Intensive Care, University of Verona, Verona, Italy
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Yao YL, Gao Y. Present Situation and Research Progress of Kidney Function Recoverability Evaluation of Acute Kidney Injury Patient. Int J Gen Med 2021; 14:1919-1925. [PMID: 34040424 PMCID: PMC8140891 DOI: 10.2147/ijgm.s303348] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/15/2021] [Indexed: 12/23/2022] Open
Abstract
Acute kidney injury (AKI) is a critical illness in clinic. The guideline recommendation of kidney disease for improving global outcomes regards urine volume and creatinine as standards to evaluate kidney functions. However, urine volume and creatinine have a certain delay for kidney function evaluation, and these would be interfered by many factors. Whether the renal function of AKI patients can recover is very important, which affects the quality of life of patients. Therefore, the present study reviews the application situation and research progress of the recoverability evaluation of AKI patient kidney function from three aspects: conventional indexes, biomarkers, and imaging methods of kidney function.
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Affiliation(s)
- Yu-Long Yao
- Department of Critical Care Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, People's Republic of China
| | - Yuan Gao
- Department of Critical Care Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, People's Republic of China
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Zdziechowska M, Gluba-Brzózka A, Franczyk B, Rysz J. Biochemical Markers in the Prediction of Contrast-induced Acute Kidney Injury. Curr Med Chem 2021; 28:1234-1250. [PMID: 32357810 DOI: 10.2174/0929867327666200502015749] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 03/21/2020] [Accepted: 03/29/2020] [Indexed: 11/22/2022]
Abstract
For many years clinicians have been searching for "kidney troponin"- a simple diagnostic tool to assess the risk of acute kidney injury (AKI). Recently, the rise in the variety of contrast-related procedures (contrast computed tomography (CT), percutaneous coronary intervention (PCI) and angiography) has resulted in the increased number of contrast-induced acute kidney injuries (CI-AKI). CIAKI remains an important cause of overall mortality, prolonged hospitalisation and it increases the total costs of therapy. The consequences of kidney dysfunction affect the quality of life and they may lead to disability as well. Despite extensive worldwide research, there are no sensitive and reliable methods of CI-AKI prediction. Kidney Injury Molecule 1 (KIM-1) and Neutrophil Gelatinase Lipocalin (NGAL) have been considered as kidney-specific molecules. High concentrations of these substances before the implementation of contrast-related procedures have been suggested to enable the estimation of kidney vulnerability to CI-AKI and they seem to have the predictive potential for cardiovascular events and overall mortality. According to other authors, routine determination of known inflammation factors (e.g., CRP, WBC, and neutrophil count) may be helpful in the prediction of CIAKI. However, the results of clinical trials provide contrasting results. The pathomechanism of contrast- induced nephropathy remains unclear. Due to its prevalence, the evaluation of the risk of acute kidney injury remains a serious problem to be solved. This paper reviews pathophysiology and suggested optimal markers facilitating the prediction of contrast-induced acute kidney injury.
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Affiliation(s)
- Magdalena Zdziechowska
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, Zeromskiego 113, 90-549 Lodz, Poland
| | - Anna Gluba-Brzózka
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, Zeromskiego 113, 90-549 Lodz, Poland
| | - Beata Franczyk
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, Zeromskiego 113, 90-549 Lodz, Poland
| | - Jacek Rysz
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, Zeromskiego 113, 90-549 Lodz, Poland
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Leyssens K, Van Regenmortel N, Roelant E, Guerti K, Couttenye MM, Jorens PG, Verbrugghe W, Van Craenenbroeck AH. Beta-Trace Protein as a Potential Marker of Acute Kidney Injury: A Pilot Study. Kidney Blood Press Res 2021; 46:185-195. [PMID: 33784671 DOI: 10.1159/000514173] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 12/24/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Acute kidney injury (AKI) is a frequent complication among patients in the intensive care unit (ICU). The limitations of serum Cr (sCr) in timely detecting AKI are well known. Beta-trace protein (BTP) is emerging as a novel endogenous glomerular filtration rate marker. The aim of this study was to explore the role of BTP as a marker of AKI. METHODS Patients admitted to the ICU undergoing surgery were included. BTP, sCr, Cystatin C (CysC), and neutrophil gelatinase-associated lipocalin (NGAL) were measured preoperatively, postoperatively (post-op), and at the first (D1) and second (D2) post-op day. AKI was defined as an increase of sCr to ≥1.5-fold from baseline within 2 days after surgery. RESULTS Of the 52 patients studied, 10 patients (19%) developed AKI. Patients with AKI were older (69.6 ± 10.7 vs. 58.1 ± 16.7 years, p = 0.043) and had a longer length of ICU stay (13 [IQR 6-49] vs. 6 [IQR 5-8] days, p = 0.032). Between the 2 groups, the evolution of BTP, sCr, CysC, and NGAL over time differed significantly, with overall higher values in the AKI group. ROC analysis for the detection of AKI within 2 days after surgery showed a great accuracy for BTP. The area under the curve (AUC) for BTP post-op; D1; and D2 was, respectively, 0.869 ± 0.049; 0.938 ± 0.035; and 0.943 ± 0.032. The discriminative power of a BTP measurement on D1 was superior in detecting AKI compared to NGAL (adjusted p value = 0.027). We could not detect a significant difference between the AUCs of other biomarkers (NGAL, sCr, and CysC). CONCLUSION Serum BTP is a promising marker for diagnosing AKI in ICU patients undergoing surgery.
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Affiliation(s)
- Katrien Leyssens
- Department of Nephrology and Hypertension, Antwerp University Hospital, Edegem, Belgium
| | | | - Ella Roelant
- Clinical Trial Center (CTC), Antwerp University Hospital, Edegem, Belgium
| | - Khadija Guerti
- Department of Clinical Chemistry, Antwerp University Hospital, Edegem, Belgium
| | - Marie Madeleine Couttenye
- Department of Nephrology and Hypertension, Antwerp University Hospital, Edegem, Belgium.,Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium
| | - Philippe G Jorens
- Department of Intensive Care Medicine, Antwerp University Hospital, Edegem, Belgium
| | - Walter Verbrugghe
- Department of Intensive Care Medicine, Antwerp University Hospital, Edegem, Belgium
| | - Amaryllis H Van Craenenbroeck
- Department of Nephrology and Renal Transplantation, University Hospital Leuven, Leuven, Belgium.,Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium
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Syed M, Syed S, Sexton K, Syeda HB, Garza M, Zozus M, Syed F, Begum S, Syed AU, Sanford J, Prior F. Application of Machine Learning in Intensive Care Unit (ICU) Settings Using MIMIC Dataset: Systematic Review. INFORMATICS-BASEL 2021; 8. [PMID: 33981592 DOI: 10.3390/informatics8010016] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Modern Intensive Care Units (ICUs) provide continuous monitoring of critically ill patients susceptible to many complications affecting morbidity and mortality. ICU settings require a high staff-to-patient ratio and generates a sheer volume of data. For clinicians, the real-time interpretation of data and decision-making is a challenging task. Machine Learning (ML) techniques in ICUs are making headway in the early detection of high-risk events due to increased processing power and freely available datasets such as the Medical Information Mart for Intensive Care (MIMIC). We conducted a systematic literature review to evaluate the effectiveness of applying ML in the ICU settings using the MIMIC dataset. A total of 322 articles were reviewed and a quantitative descriptive analysis was performed on 61 qualified articles that applied ML techniques in ICU settings using MIMIC data. We assembled the qualified articles to provide insights into the areas of application, clinical variables used, and treatment outcomes that can pave the way for further adoption of this promising technology and possible use in routine clinical decision-making. The lessons learned from our review can provide guidance to researchers on application of ML techniques to increase their rate of adoption in healthcare.
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Affiliation(s)
- Mahanazuddin Syed
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences (UAMS), Little Rock, Arkansas 72205, USA
| | - Shorabuddin Syed
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences (UAMS), Little Rock, Arkansas 72205, USA
| | - Kevin Sexton
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences (UAMS), Little Rock, Arkansas 72205, USA
- Department of Surgery, University of Arkansas for Medical Sciences (UAMS), Little Rock, Arkansas 72205, USA
- Department of Health Policy and Management, University of Arkansas for Medical Sciences (UAMS), Little Rock, Arkansas 72205, USA
| | - Hafsa Bareen Syeda
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences (UAMS), Little Rock, Arkansas 72205, USA
| | - Maryam Garza
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences (UAMS), Little Rock, Arkansas 72205, USA
| | - Meredith Zozus
- Department of Population Health Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229, USA
| | - Farhanuddin Syed
- Shadan Institute of Medical Sciences, College of Medicine, Hyderabad, Telangana 500086, India
| | - Salma Begum
- Department of Information Technology, University of Arkansas for Medical Sciences (UAMS), Little Rock, Arkansas 72205, USA
| | - Abdullah Usama Syed
- Department of Information Science, University of Arkansas at Little Rock (UALR), Little Rock, Arkansas 72205, USA
| | - Joseph Sanford
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences (UAMS), Little Rock, Arkansas 72205, USA
- Department of Anesthesiology, University of Arkansas for Medical Sciences (UAMS), Little Rock, Arkansas 72205, USA
| | - Fred Prior
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences (UAMS), Little Rock, Arkansas 72205, USA
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Rawls KD, Dougherty BV, Vinnakota KC, Pannala VR, Wallqvist A, Kolling GL, Papin JA. Predicting changes in renal metabolism after compound exposure with a genome-scale metabolic model. Toxicol Appl Pharmacol 2021; 412:115390. [PMID: 33387578 PMCID: PMC7859602 DOI: 10.1016/j.taap.2020.115390] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 11/02/2020] [Accepted: 12/26/2020] [Indexed: 12/12/2022]
Abstract
The kidneys are metabolically active organs with importance in several physiological tasks such as the secretion of soluble wastes into the urine and synthesizing glucose and oxidizing fatty acids for energy in fasting (non-fed) conditions. Once damaged, the metabolic capability of the kidneys becomes altered. Here, we define metabolic tasks in a computational modeling framework to capture kidney function in an update to the iRno network reconstruction of rat metabolism using literature-based evidence. To demonstrate the utility of iRno for predicting kidney function, we exposed primary rat renal proximal tubule epithelial cells to four compounds with varying levels of nephrotoxicity (acetaminophen, gentamicin, 2,3,7,8-tetrachlorodibenzodioxin, and trichloroethylene) for six and twenty-four hours, and collected transcriptomics and metabolomics data to measure the metabolic effects of compound exposure. For the transcriptomics data, we observed changes in fatty acid metabolism and amino acid metabolism, as well as changes in existing markers of kidney function such as Clu (clusterin). The iRno metabolic network reconstruction was used to predict alterations in these same pathways after integrating transcriptomics data and was able to distinguish between select compound-specific effects on the proximal tubule epithelial cells. Genome-scale metabolic network reconstructions with coupled omics data can be used to predict changes in metabolism as a step towards identifying novel metabolic biomarkers of kidney function and dysfunction.
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Affiliation(s)
- Kristopher D Rawls
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA 22908, USA
| | - Bonnie V Dougherty
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA 22908, USA
| | - Kalyan C Vinnakota
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, U.S. Army Medical Research and Development Command, Fort Detrick, MD 21702, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. (HJF), Bethesda, MD 20817, USA
| | - Venkat R Pannala
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, U.S. Army Medical Research and Development Command, Fort Detrick, MD 21702, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. (HJF), Bethesda, MD 20817, USA
| | - Anders Wallqvist
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, U.S. Army Medical Research and Development Command, Fort Detrick, MD 21702, USA
| | - Glynis L Kolling
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA 22908, USA; Department of Medicine, Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA 22908, USA
| | - Jason A Papin
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA 22908, USA; Department of Medicine, Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA 22908, USA; Department of Biochemistry & Molecular Genetics, University of Virginia, Charlottesville, VA 22908, USA.
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15
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Xu X, Zhu R, Ying J, Zhao M, Wu X, Cao G, Wang K. Nephrotoxicity of Herbal Medicine and Its Prevention. Front Pharmacol 2020; 11:569551. [PMID: 33178019 PMCID: PMC7593559 DOI: 10.3389/fphar.2020.569551] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/14/2020] [Indexed: 01/31/2023] Open
Abstract
Herbal medicine (HM) has been widely used to treat diseases for thousands of years and has greatly contributed to the health of human beings. Many new drugs have been developed from HM, such as artemisinin. However, artemisinin has adverse effects, such as renal toxicity. In 1993, a study conducted in Belgium reported for the first time that the root extracts of Aristolochia obliqua S. M. Hwang led to progressive interstitial renal fibrosis. The nephrotoxicity of HM has attracted worldwide attention. More than 100 kinds of HM induce renal toxicity, including some herbs, animal HMs, and minerals. This paper aimed to summarize the HM compounds that cause nephrotoxicity, the mechanisms underlying the toxicity of these compounds, biomarkers of renal injury, and prevention strategies. These findings provide a basis for follow-up studies on the prevention and treatment of HM nephrotoxicity.
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Affiliation(s)
- Xiaofen Xu
- School of Pharmacy, Zhejiang Chinese Medical University, Hangzhou, China
| | - Ruyi Zhu
- School of Pharmacy, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jialiang Ying
- School of Pharmacy, Zhejiang Chinese Medical University, Hangzhou, China
| | - Mengting Zhao
- School of Pharmacy, Guizhou University of Traditional Chinese Medicine, Guiyang, China
| | - Xin Wu
- School of Pharmacy, Zhejiang Chinese Medical University, Hangzhou, China
| | - Gang Cao
- School of Pharmacy, Zhejiang Chinese Medical University, Hangzhou, China
| | - Kuilong Wang
- School of Pharmacy, Zhejiang Chinese Medical University, Hangzhou, China
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16
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Danjuma MI, Al Shokri S, Bakhsh N, Alamin MA, Mohamedali MG, Tamuno I. The utility of kidney injury molecule-1 as an early biomarker of kidney injury in people living with HIV. Int J STD AIDS 2020; 31:1228-1237. [PMID: 32951563 PMCID: PMC7754827 DOI: 10.1177/0956462420918515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
There are increasing reports of antiretroviral therapy (ART) drug-related kidney dysfunction. Traditional markers of kidney dysfunction such as urine protein/creatinine ratio and estimated glomerular filtration rate (eGFR) have thus far proven ineffective at detecting some sub-clinical forms of ART-related kidney injury. This is a cross-sectional examination of 114 people living with HIV (PLWH), either naïve (N =104) or treatment experienced (N =10). Urinary kidney injury molecule-1 (KIM-1 ng/mg) thresholds were estimated using electrochemiluminescent assays from stored urine samples and normalised for urinary creatinine excretion (KIM-1/Cr). Correlation coefficients and predictors of kidney tubular injury were compared and derived for both adjusted and unadjusted urinary KIM-1/CR (ng/mg). In PLWH (both ART-naïve and treatment experienced) had a higher baseline unadjusted and adjusted median (≥3.7 ng/mg) and upper tertile (≥6.25 ng/mg) urinary KIM-1/Cr levels compared to either non-normal volunteers (0.39 ng/mg) or those with acute kidney injury in the general population (0.57 ng/mg). When upper tertile KIM-1/Cr (≥6.25 ng/mg) was utilised as a marker of kidney injury, eGFR (ml/min/1.73 m2), white Caucasian ethnicity, and protease inhibitor exposure were significantly associated with increased risk of kidney injury in multivariate analyses (odds ratio 0.91, confidence interval [CI] 0.68–0.98, P = 0.02; odds ratio 8.9, CI 1.6–48.6, p = 0.01; and odds ratio 0.05, CI 0.03–0.9, p =0.04, respectively). We found a significant degree of sub-clinical kidney injury (high unadjusted and adjusted KIM-1/Cr) in PLWH with normal kidney function (eGFR ≥60 ml/min/1.73 m2). We also found a higher baseline KIM-1/Cr (ng/mg) in our study cohort than reported both in normal volunteers and patients with kidney injury in the general population.
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Affiliation(s)
| | - Shaikha Al Shokri
- Department of Medical Education, Hamad Medical Corporation, Doha, Qatar
| | - Nadia Bakhsh
- Department of Medical Education, Hamad Medical Corporation, Doha, Qatar
| | - Mohammed A Alamin
- Department of Medical Education, Hamad Medical Corporation, Doha, Qatar
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Impact of Pneumoperitoneum on the Development of Acute Kidney Injury: Comparison Between Normal and Diabetic Rats. Surg Laparosc Endosc Percutan Tech 2020; 31:136-141. [PMID: 32910109 DOI: 10.1097/sle.0000000000000859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 05/27/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Minimally invasive surgery is considered the gold-standard approach for many surgical procedures. However, it requires CO2 insufflation and elevated intra-abdominal pressure (IAP), which may result in adverse pulmonary, cardiovascular, gastrointestinal, and renal changes. The kidneys are highly sensitive to pressure changes, where risk factors such as severe infection, dehydration, older age, and chronic kidney disease may aggravate the likelihood for the development of acute kidney injury (AKI). Unfortunately, the impact of diabetes mellitus on the deleterious effects of elevated IAP-induced AKI was not fully studied so far. The present study was designed to examine the effect of pneumoperitoneum on renal function and the development of AKI in diabetic rats. MATERIALS AND METHODS Sprague Dawley rats were divided into 2 groups: control (nondiabetic) rats (n=7) and diabetic rats (n=10). A Veress needle was introduced through the supravesical incision where inflating CO2 allowing the IAP to be increased to the desired pressures 7, 10, and 14 mm Hg for 45 minutes each and at the end of the experiment, the pressure was deflated to zero. During each pressure point, hemodynamic parameters were recorded and urine and blood samples were collected for analysis. RESULTS The baseline values of renal hemodynamic were significantly lower in diabetic rats. There were no major statistically significant changes from baseline in urinary flow, urinary sodium excretion (UNaV), glomerular filtration rate, and renal plasma flow during 7 mm Hg pressure in both groups. When the IAP was further elevated, a significant deterioration of these parameters was recorded. This trend was more pronounced among diabetic rats. When examining urinary neutrophil gelatinase-associated lipocalin, a linear correlation was observed between the IAP and the biomarker level. This correlation was more significant in the diabetic group. CONCLUSION The present study demonstrated a direct correlation between IAP elevation and the development of AKI. Diabetic rats were more sensitive to the deleterious effect of pneumoperitoneum, where urinary neutrophil gelatinase-associated lipocalin levels may be used as a future biomarker to predict postoperative AKI, especially in patients with diabetes.
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Karaman E, Ariman I, Ozden S. Responses of oxidative stress and inflammatory cytokines after zearalenone exposure in human kidney cells. WORLD MYCOTOXIN J 2020. [DOI: 10.3920/wmj2019.2512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Zearalenone is a mycotoxin widely found worldwide that is produced by several fungal species. Due to its similarity to estradiol, it has been shown to have toxic effects on the reproductive system. Although various animal studies have been conducted to investigate the toxic effects of zearalenone, the mechanisms of toxicity have not been fully elucidated. The aim of the study was to investigate the dose-dependent toxic effects of zearalenone exposure in human kidney cells. The half-maximal inhibitory concentration values of zearalenone in HK-2 cells were found to be 133.42 and 101.74 µM in MTT- and NRU-tests, respectively. Zearalenone exposure at concentrations of 1, 10 and 50 µM decreased cell proliferation by 2.1, 11.07 and 24.34%, respectively. Reactive oxygen species levels increased significantly in a dose-dependent manner. A significant increase was observed in the expressions of MGMT, α-GST, Hsp70 and HO-1 genes, which are associated with oxidative damage, while a significant decrease in L-Fabp gene expression was observed. Moreover, zearalenone increased gene expression of inflammatory cytokines, such as IL-6, IL-8, TNFα and MAPK8. Significant increases were observed at the level of global DNA methylation and expression of DNMT1 in all exposure groups. These results indicate that changes in DNA methylation and oxidative damage may play an important role in the toxicity of zearalenone.
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Affiliation(s)
- E.F. Karaman
- Department of Pharmaceutical Toxicology, Faculty of Pharmacy, Istanbul University, 34116-Beyazit, Istanbul, Turkey
- Department of Pharmaceutical Toxicology, Faculty of Pharmacy, Biruni University, 34010-Topkapi, Istanbul, Turkey
| | - I. Ariman
- Department of Pharmaceutical Toxicology, Faculty of Pharmacy, Istanbul University, 34116-Beyazit, Istanbul, Turkey
| | - S. Ozden
- Department of Pharmaceutical Toxicology, Faculty of Pharmacy, Istanbul University, 34116-Beyazit, Istanbul, Turkey
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Normoxic re-oxygenation ameliorates end-organ injury after cardiopulmonary bypass. J Cardiothorac Surg 2020; 15:134. [PMID: 32522213 PMCID: PMC7285475 DOI: 10.1186/s13019-020-01173-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 05/31/2020] [Indexed: 01/12/2023] Open
Abstract
Background In a rabbit model of cardiopulmonary bypass (CPB) and cardioplegic arrest, we previously showed that hyperoxic myocardial reperfusion was associated with increased left ventricular (LV) systolic dysfunction and myocardial injury compared with normoxic reperfusion. The aim of this study was to evaluate in our experimental model the impact of post-CPB reperfusion conditions on other organs potentially vulnerable to ischemic injury such as the brain and kidney. Methods After 60 min of CPB, aortic cross-clamp, and cold cardioplegic arrest, rabbits were reperfused under hyperoxic or normoxic conditions for 120 min. Left ventricular systolic contractility (LV + dP/dt) and diastolic relaxation (LV –dP/dt) were continuously recorded, and end-organ injury was assessed by measuring circulating biomarkers specific for kidney (cystatin C and creatinine) and brain injury [S100B and neuron specific enolase (NSE)]. At completion of the protocol, kidney and brain tissues were harvested for measuring oxidant stress (OS), inflammation and apoptosis. Results Following aortic cross-clamp removal, rabbits exposed to normoxic reperfusion demonstrated preserved LV systolic and diastolic function compared with hyperoxic reperfusion (LV + dP/dt: 70 ± 14% of pre-CPB vs. 36 ± 21%, p = 0.018; LV -dP/dt: 72 ± 36% of pre-CPB vs. 33 ± 20%, p = 0.023). Similarly, CPB increased plasma creatinine, S100B and NSE that were significantly attenuated by normoxic reperfusion compared with hyperoxic reperfusion (creatinine: 4.0 ± 0.5 vs. 7.1 ± 0.8 mg/dL, p = 0.004; S100B: 4.0 ± 0.8 vs. 6.7 ± 1.0 ng/mL, p = 0.047; NSE: 57.7 ± 6.8 vs. 101.3 ± 16.1 pg/mL, p = 0.040). Furthermore, both kidney and brain tissues showed increased mRNA expression and activation of pathways for OS, inflammation, and apoptosis, that were reduced under normoxic compared with hyperoxic conditions. Conclusions Normoxic reperfusion ameliorates cardiac, renal and neural injury compared with hyperoxic reperfusion in an in vivo animal model of CPB and cardioplegic arrest. This protective effect of normoxic reperfusion may be due to a reduction in signaling pathways for OS, inflammation, and apoptosis.
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Relation of Copeptin with Diabetic and Renal Function Markers Among Patients with Diabetes Mellitus Progressing Towards Diabetic Nephropathy. Arch Med Res 2020; 51:548-555. [PMID: 32505416 DOI: 10.1016/j.arcmed.2020.05.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/10/2020] [Accepted: 05/21/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Arginine vasopressin (AVP) plays an important role in the pathophysiology of Diabetes Mellitus (DM) and its related complications like diabetic nephropathy. Copeptin is considered as a reliable surrogate biomarker of AVP. If raised levels of copeptin in diabetic patients are detected earlier, prognosis of DM can be improved by timely modulating the treatment strategy. AIMS OF THE STUDY The study is therefore planned to assess copeptin levels in different groups of DM and in healthy controls to suggest a better and reliable biomarker for progressive stages of DM. METHODS Subjects were recruited as controls, pre diabetes, DM without nephropathy and diabetic nephropathy. Serum copeptin levels were measured by ELISA. While, Blood Urea Nitrogen (BUN), creatinine, Glycosylated Hemoglobin (HbA1c) and spot urinary albumin creatinine ratio (UACR) were done using spectrophotometry. Statistical analysis was done using ANOVA and Pearson's correlation tests on SPSS. RESULTS The average copeptin levels were 215.096 pg/mL. Copeptin levels were significantly elevated in subjects with positive family history of DM (p = 0.025), levels were also raised in pre diabetes kpatients (252.85 pg/mL) as compared to other groups. Copeptin levels were also correlated with HbA1c r = 0.171 (p = 0.101), BUN r = 0.244 (p = 0.007), creatinine r = 0.215 (p = 0.018), UACR r = 0.375 (p = <0.001) and GFR r = 0.215 (p = <0.019). CONCLUSION The significant correlation of copeptin with diabetic and renal biomarkers, along with its positive association with family history of DM support its' role as an early and reliable biomarker of DM and its associated nephropathy.
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Hussain ML, Hamid PF, Chakane N. Will urinary biomarkers provide a breakthrough in diagnosing cardiac surgery-associated AKI? - A systematic review. Biomarkers 2020; 25:375-383. [PMID: 32479185 DOI: 10.1080/1354750x.2020.1777199] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Acute kidney injury following cardiac surgery is a dreaded complication contributing to early mortality. Diagnosing AKI using serum creatinine usually results in a delay. To combat this, certain kidney damage specific biomarkers were investigated to identify if they can serve as early predictors of cardiac surgery-associated AKI (CSA-AKI). This study systematically reviews three such biomarkers; NGAL, tissue inhibitor of matrix metalloproteinase-2 (TIMP-2) and insulin-like growth factor binding protein-7 (IGFBP7) to identify if they can serve as early predictors of CSA-AKI.Methods: Systematic search was carried out on literature reporting the diagnostic ability of the three biomarkers from databases in accordance with PRISMA guidelines.Results: We found 43 articles reporting urinary-NGAL levels (n = 34 in adults, n = 9 in children) and 10 studies reporting TIMP-2 and IGFBP7 levels among adults. Interestingly, NGAL showed high diagnostic value in predicting AKI in children (seven among nine studies with AUROC > 0.8). The cell cycle arrest biomarkers, namely TIMP-2 and IGFBP7, showed high diagnostic value in predicting AKI in adults (five among ten studies with AUROC > 0.8).Conclusion: In predicting CSA-AKI; the diagnostic value of NGAL is high in the paediatric population while the diagnostic value of TIMP-2 and IGFBP7 is high in adults.
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Affiliation(s)
- Mohmmed Laique Hussain
- Medical Research, California Institute of Behavioural Neurosciences and Psychology, Fairfield, CA, USA
| | - Pousette Farouk Hamid
- Medical Research, California Institute of Behavioural Neurosciences and Psychology, Fairfield, CA, USA
| | - Ntema Chakane
- Medical Research, California Institute of Behavioural Neurosciences and Psychology, Fairfield, CA, USA
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Loosen SH, Tacke F, Püthe N, Binneboesel M, Wiltberger G, Alizai PH, Kather JN, Paffenholz P, Ritz T, Koch A, Bergmann F, Trautwein C, Longerich T, Roderburg C, Neumann UP, Luedde T. High baseline soluble urokinase plasminogen activator receptor (suPAR) serum levels indicate adverse outcome after resection of pancreatic adenocarcinoma. Carcinogenesis 2020; 40:947-955. [PMID: 30805627 PMCID: PMC6735890 DOI: 10.1093/carcin/bgz033] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 01/22/2019] [Accepted: 02/15/2019] [Indexed: 12/29/2022] Open
Abstract
Surgical resection represents the only potentially curative therapy for patients with pancreatic adenocarcinoma (PDAC), an aggressive malignancy with a very limited 5-year survival rate. However, even after complete tumor resection, many patients are still facing an unfavorable prognosis underlining the need for better preoperative stratification algorithms. Here, we explored the role of the secreted glycoprotein soluble urokinase plasminogen activator receptor (suPAR) as a novel circulating biomarker for patients undergoing resection of PDAC. Serum levels of suPAR were measured by enzyme-linked immunosorbent assay (ELISA) in an exploratory as well as a validation cohort comprising a total of 127 PDAC patients and 75 healthy controls. Correlating with a cytoplasmic immunohistochemical expression of uPAR in PDAC tumor cells, serum levels of suPAR were significantly elevated in PDAC patients compared to healthy controls and patient with PDAC precursor lesions. Importantly, patients with high preoperative suPAR levels above a calculated cutoff value of 5.956 ng/ml showed a significantly reduced overall survival after tumor resection. The prognostic role of suPAR was further corroborated by uni- and multivariate Cox-regression analyses including parameters of systemic inflammation, liver and kidney function as well as clinico-pathological patients’ characteristics. Moreover, high baseline suPAR levels identified those patients particularly susceptible to acute kidney injury and surgical complications after surgery. In conclusion, our data suggest that circulating suPAR represents a novel prognostic marker in PDAC patients undergoing tumor resection that might be a useful addition to existing preoperative stratification algorithms for identifying patients that particularly benefit from extended tumor resection.
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Affiliation(s)
- Sven H Loosen
- Department of Medicine III, Hepatology and Hepatobiliary Oncology, Pauwelsstrasse, Aachen, Germany
| | - Frank Tacke
- Department of Medicine III, Hepatology and Hepatobiliary Oncology, Pauwelsstrasse, Aachen, Germany
| | - Niklas Püthe
- Division of Gastroenterology, Hepatology and Hepatobiliary Oncology, Pauwelsstrasse, Aachen, Germany
| | - Marcel Binneboesel
- Department of Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Pauwelsstrasse, Aachen, Germany.,Department of General and Visceral Surgery, Klinikum Bielefeld, Bielefeld, Germany
| | - Georg Wiltberger
- Department of Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Pauwelsstrasse, Aachen, Germany
| | - Patrick H Alizai
- Department of Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Pauwelsstrasse, Aachen, Germany
| | - Jakob N Kather
- Department of Medicine III, Hepatology and Hepatobiliary Oncology, Pauwelsstrasse, Aachen, Germany
| | - Pia Paffenholz
- Department of Urology, University Hospital Cologne, Kerpener Straße, Germany
| | - Thomas Ritz
- Institute of Pathology, University Hospital RWTH Aachen, Pauwelsstrasse, Aachen, Germany.,Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld, Heidelberg, Germany
| | - Alexander Koch
- Department of Medicine III, Hepatology and Hepatobiliary Oncology, Pauwelsstrasse, Aachen, Germany
| | - Frank Bergmann
- Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld, Heidelberg, Germany
| | - Christian Trautwein
- Department of Medicine III, Hepatology and Hepatobiliary Oncology, Pauwelsstrasse, Aachen, Germany
| | - Thomas Longerich
- Institute of Pathology, University Hospital RWTH Aachen, Pauwelsstrasse, Aachen, Germany.,Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld, Heidelberg, Germany
| | - Christoph Roderburg
- Department of Medicine III, Hepatology and Hepatobiliary Oncology, Pauwelsstrasse, Aachen, Germany
| | - Ulf P Neumann
- Department of Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Pauwelsstrasse, Aachen, Germany
| | - Tom Luedde
- Department of Medicine III, Hepatology and Hepatobiliary Oncology, Pauwelsstrasse, Aachen, Germany.,Division of Gastroenterology, Hepatology and Hepatobiliary Oncology, Pauwelsstrasse, Aachen, Germany
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The effect of melatonin on cisplatin-induced nephrotoxicity: A pilot, randomized, double-blinded, placebo-controlled clinical trial. Eur J Integr Med 2020. [DOI: 10.1016/j.eujim.2020.101065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Kashani K, Rosner MH, Ostermann M. Creatinine: From physiology to clinical application. Eur J Intern Med 2020; 72:9-14. [PMID: 31708357 DOI: 10.1016/j.ejim.2019.10.025] [Citation(s) in RCA: 144] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/05/2019] [Accepted: 10/22/2019] [Indexed: 12/22/2022]
Abstract
Estimating static kidney function accurately and detecting changes in kidney function in a timely fashion are challenging but critically important tasks. Serum creatinine is the most widely used functional biomarker of the kidney. However, its use is associated with substantial shortcomings. Understanding these shortcomings is critical in allowing accurate interpretation of creatinine values and translating them into changes in kidney function. In this review, the pathways involved in creatinine generation and metabolism as well as the techniques involved in measuring creatinine concentrations are discussed. This allows for the discussion of the value and pitfalls in using creatinine as a marker of kidney function. In addition, information regarding alternative functional biomarkers of the kidney is provided.
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Affiliation(s)
- Kianoush Kashani
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States; Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, United States.
| | - Mitchell H Rosner
- Division of Nephrology, University of Virginia Health System, Charlottesville, VA, United States
| | - Marlies Ostermann
- King's College London, Guy's & St Thomas' Hospital, London, United Kingdom
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Loosen SH, Breuer A, Tacke F, Kather JN, Gorgulho J, Alizai PH, Bednarsch J, Roeth AA, Lurje G, Schmitz SM, Brozat JF, Paffenholz P, Vucur M, Ritz T, Koch A, Trautwein C, Ulmer TF, Roderburg C, Longerich T, Neumann UP, Luedde T. Circulating levels of soluble urokinase plasminogen activator receptor predict outcome after resection of biliary tract cancer. JHEP Rep 2020; 2:100080. [PMID: 32140677 PMCID: PMC7049662 DOI: 10.1016/j.jhepr.2020.100080] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/06/2020] [Accepted: 01/08/2020] [Indexed: 12/11/2022] Open
Abstract
Background & Aims Surgical resection is the only potentially curative therapy for patients with biliary tract cancer (BTC), but 5-year survival rates after tumor resection have remained below 30%, corroborating the need for better stratification tools to identify the ideal surgical candidates. The soluble urokinase plasminogen activator receptor (suPAR) represents a mediator of inflammation and has been associated with distinct types of cancer. In this study, we evaluated a potential role of suPAR as a novel biomarker in patients undergoing BTC resection. Methods Tumor expression of uPAR was analyzed by immunohistochemistry in 108 BTC samples. Serum levels of suPAR were analyzed by ELISA in a training and validation cohort comprising a total of 117 patients with BTC and 76 healthy controls. Results High tumoral uPAR expression was associated with an adverse outcome after BTC resection. Accordingly, circulating levels of suPAR were significantly elevated in patients with BTC compared to healthy controls, as well as in patients with primary sclerosing cholangitis. Using a small training set, we established an optimal prognostic suPAR cut-off value of 3.72 ng/ml for patients with BTC. Importantly, preoperative suPAR serum levels above this cut-off value were associated with significantly impaired overall survival in both the training and validation cohort. Multivariate Cox-regression analysis including various clinicopathological parameters such as tumor stage, markers of inflammation and organ dysfunction, as well as tumor markers, revealed circulating suPAR levels as an independent prognostic marker following BTC resection. Finally, high preoperative suPAR levels were indicative of acute kidney injury after tumor resection. Conclusion Circulating suPAR represents a previously unrecognized biomarker in patients with resectable BTC, which might help to preoperatively identify the ideal candidates for liver surgery. Lay summary Surgical resection represents the only curative treatment option for patients with biliary tract cancer, but not all patients benefit to the same extent in terms of overall survival. Here, we provide evidence that serum levels of an inflammatory mediator (suPAR) are indicative of a patient's postoperative outcome and might thus help to identify the ideal surgical candidates. Biliary tract cancer is associated with poor outcomes and increasing incidence. Surgical resection is the only potentially curative treatment option for patients with biliary tract cancer. The identification of ideal surgical candidates has remained challenging. Circulating suPAR represents a novel diagnostic and prognostic biomarker in resectable patients. SuPAR might be useful to identify patients with biliary tract cancer who will benefit most from tumor resection.
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Key Words
- AKI, acute kidney injury
- ALP, alkaline phosphatase
- ALT, alanine aminotransferase
- AST, aspartate aminotransferase
- BMI, body mass index
- BTC
- BTC, biliary tract cancer
- CA19-9
- CA19-9, carbohydrate antigen 19-9
- CCA
- CEA
- CEA, carcinoembryonic antigen
- CRP, C-reactive protein
- ECOG PS, Eastern Cooperative Oncology Group performance status
- HR, hazard ratio
- IRS, immunoreactive score
- OR, odds ratio
- OS, overall survival
- PSC, primary sclerosing cholangitis
- acute kidney injury
- biomarker
- cholangiocarcinoma
- suPAR
- suPAR, soluble uPAR
- uPAR, urokinase plasminogen activator receptor
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Affiliation(s)
- Sven H. Loosen
- Department of Medicine III, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Annemarie Breuer
- Division of Gastroenterology, Hepatology and Hepatobiliary Oncology, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Frank Tacke
- Department of Medicine III, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
- Department of Hepatology and Gastroenterology, Charité University Medicine Berlin, Augustenburger Platz 1, 10117 Berlin, Germany
| | - Jakob N. Kather
- Department of Medicine III, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Joao Gorgulho
- Division of Gastroenterology, Hepatology and Hepatobiliary Oncology, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Patrick H. Alizai
- Department of Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Jan Bednarsch
- Department of Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Anjali A. Roeth
- Department of Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Georg Lurje
- Department of Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Sophia M. Schmitz
- Department of Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Jonathan F. Brozat
- Department of Medicine III, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Pia Paffenholz
- Department of Urology, University Hospital Cologne, Kerpener Straβe 62, 50937 Cologne, Germany
| | - Mihael Vucur
- Division of Gastroenterology, Hepatology and Hepatobiliary Oncology, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Thomas Ritz
- Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120 Heidelberg, Germany
| | - Alexander Koch
- Department of Medicine III, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Christian Trautwein
- Department of Medicine III, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Tom F. Ulmer
- Department of Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Christoph Roderburg
- Department of Medicine III, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
- Department of Hepatology and Gastroenterology, Charité University Medicine Berlin, Augustenburger Platz 1, 10117 Berlin, Germany
| | - Thomas Longerich
- Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120 Heidelberg, Germany
| | - Ulf P. Neumann
- Department of Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
- Department of Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Tom Luedde
- Department of Medicine III, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
- Division of Gastroenterology, Hepatology and Hepatobiliary Oncology, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
- Corresponding author. Addresses: Division of Gastroenterology, Hepatology and Hepatobiliary Oncology, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
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Chen CT, Chang LY, Chuang CW, Wang SC, Kao MC, Tzeng IS, Kuo KL, Wu CC, Tsai PS, Huang CJ. Optimal measuring timing of cystatin C for early detection of contrast-induced acute kidney injury: A systematic review and meta-analysis. Toxicol Lett 2020; 318:65-73. [PMID: 31654803 DOI: 10.1016/j.toxlet.2019.10.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 09/18/2019] [Accepted: 10/16/2019] [Indexed: 11/26/2022]
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Near-Infrared-Based Cerebral Oximetry for Prediction of Severe Acute Kidney Injury in Critically Ill Children After Cardiac Surgery. Crit Care Explor 2019; 1:e0063. [PMID: 32166244 PMCID: PMC7063924 DOI: 10.1097/cce.0000000000000063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Supplemental Digital Content is available in the text. Cerebral oximetry by near-infrared spectroscopy is used frequently in critically ill children but guidelines on its use for decision making in the PICU are lacking. We investigated cerebral near-infrared spectroscopy oximetry in its ability to predict severe acute kidney injury after pediatric cardiac surgery and assessed its additional predictive value to routinely collected data.
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Li F, Hu L, Zhao X, Ge W, Pan H, Zhang W, Jiang Y, Xu X, Hou J, Pu J. The value of cystatin C and urinary and serum neutrophil gelatinase-associated lipocalin during the perioperative period of renal transplantation. Transl Androl Urol 2019; 8:432-441. [PMID: 31807420 DOI: 10.21037/tau.2019.08.12] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background The perioperative management of renal transplantation is complex. Our research aimed to study the clinical value of cystatin-C (Cys-C) and urinary and serum neutrophil gelatinase-associated lipocalin (NGAL) during the perioperative period of renal transplantation. Methods We collected the clinical information of 47 renal transplantation patients. Urine and serum samples were collected daily until the second week and then weekly until discharge to determine serum NGAL (s-NGAL), urine NGAL (u-NGAL), serum creatinine (s-Cr), and Cys-C levels. Receiver-operating characteristic (ROC) analysis was used, and the area under the curve (AUC) was compared to evaluate the accuracy of the diagnosis of delayed graft function (DGF). Multivariable analysis was used to find the association between the markers and renal function at discharge. Results In our research, the value of Cys-C, serum NGAL, and urine NGAL were higher in DGF group. In the ROC analysis, Cys-C had the highest AUC (0.939) compared with s-NGAL (0.909), u-NGAL (0.856), and s-Cr (0.747). Multivariable analysis showed that Cys-C levels in the first week after the operation and cold ischemia time were independently associated with estimated glomerular filtration rate (eGFR) at discharge (P<0.05). Conclusions Our results showed that Cys-C, serum NGAL, and urine NGAL could reflect renal function sensitively. Cys-C had the highest sum of sensitivity and specificity at 4.77 mg/L, with a sensitivity of 0.818 and specificity of 0.889. The Cys-C level during the first week after the operation was independently associated with eGFR at discharge and could predict the short-term prognosis of renal transplantation patients.
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Affiliation(s)
- Feng Li
- Department of Urinary Surgery, The First Affiliated Hospital, Soochow University, Suzhou 215006, China
| | - Linkun Hu
- Department of Urinary Surgery, The First Affiliated Hospital, Soochow University, Suzhou 215006, China
| | - Xiaojun Zhao
- Department of Urinary Surgery, The First Affiliated Hospital, Soochow University, Suzhou 215006, China
| | - Wenqing Ge
- Department of Urinary Surgery, The First Affiliated Hospital, Soochow University, Suzhou 215006, China
| | - Hao Pan
- Department of Urinary Surgery, The First Affiliated Hospital, Soochow University, Suzhou 215006, China
| | - Wei Zhang
- Department of Urinary Surgery, The First Affiliated Hospital, Soochow University, Suzhou 215006, China
| | - Yufeng Jiang
- Department of Urinary Surgery, The First Affiliated Hospital, Soochow University, Suzhou 215006, China
| | - Xu Xu
- Department of Urinary Surgery, The First Affiliated Hospital, Soochow University, Suzhou 215006, China
| | - Jianquan Hou
- Department of Urinary Surgery, The First Affiliated Hospital, Soochow University, Suzhou 215006, China
| | - Jinxian Pu
- Department of Urinary Surgery, The First Affiliated Hospital, Soochow University, Suzhou 215006, China
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Predictive Factors of Duration of Continuous Renal Replacement Therapy in Acute Kidney Injury Survivors. Shock 2019; 52:598-603. [DOI: 10.1097/shk.0000000000001328] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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30
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Omage K, Azeke MA. ACALYPHA WILKESIANA regulates fluid volume but affects selected tissues in salt loaded rabbits. CLINICAL PHYTOSCIENCE 2019. [DOI: 10.1186/s40816-019-0103-5] [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: 11/10/2022] Open
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Flechet M, Falini S, Bonetti C, Güiza F, Schetz M, Van den Berghe G, Meyfroidt G. Machine learning versus physicians' prediction of acute kidney injury in critically ill adults: a prospective evaluation of the AKIpredictor. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:282. [PMID: 31420056 PMCID: PMC6697946 DOI: 10.1186/s13054-019-2563-x] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/07/2019] [Indexed: 12/15/2022]
Abstract
Background Early diagnosis of acute kidney injury (AKI) is a major challenge in the intensive care unit (ICU). The AKIpredictor is a set of machine-learning-based prediction models for AKI using routinely collected patient information, and accessible online. In order to evaluate its clinical value, the AKIpredictor was compared to physicians’ predictions. Methods Prospective observational study in five ICUs of a tertiary academic center. Critically ill adults without end-stage renal disease or AKI upon admission were considered for enrollment. Using structured questionnaires, physicians were asked upon admission, on the first morning, and after 24 h to predict the development of AKI stages 2 or 3 (AKI-23) during the first week of ICU stay. Discrimination, calibration, and net benefit of physicians’ predictions were compared against the ones by the AKIpredictor. Results Two hundred fifty-two patients were included, 30 (12%) developed AKI-23. In the cohort of patients with predictions by physicians and AKIpredictor, the performance of physicians and AKIpredictor were respectively upon ICU admission, area under the receiver operating characteristic curve (AUROC) 0.80 [0.69–0.92] versus 0.75 [0.62–0.88] (n = 120, P = 0.25) with net benefit in ranges 0–26% versus 0–74%; on the first morning, AUROC 0.94 [0.89–0.98] versus 0.89 [0.82–0.97] (n = 187, P = 0.27) with main net benefit in ranges 0–10% versus 0–48%; after 24 h, AUROC 0.95 [0.89–1.00] versus 0.89 [0.79–0.99] (n = 89, P = 0.09) with main net benefit in ranges 0–67% versus 0–50%. Conclusions The machine-learning-based AKIpredictor achieved similar discriminative performance as physicians for prediction of AKI-23, and higher net benefit overall, because physicians overestimated the risk of AKI. This suggests an added value of the systematic risk stratification by the AKIpredictor to physicians’ predictions, in particular to select high-risk patients or reduce false positives in studies evaluating new and potentially harmful therapies. Due to the low event rate, future studies are needed to validate these findings. Trial registration ClinicalTrials.gov, NCT03574896 registration date: July 2nd, 2018 Electronic supplementary material The online version of this article (10.1186/s13054-019-2563-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marine Flechet
- Clinical Division and Laboratory of Intensive Care Medicine, Academic Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, B-3000, Leuven, Belgium
| | - Stefano Falini
- Department of Anesthesia and General Intensive Care, Humanitas Clinical and Research Center, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Claudia Bonetti
- University of Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, 20126, Milan, Italy
| | - Fabian Güiza
- Clinical Division and Laboratory of Intensive Care Medicine, Academic Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, B-3000, Leuven, Belgium
| | - Miet Schetz
- Clinical Division and Laboratory of Intensive Care Medicine, Academic Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, B-3000, Leuven, Belgium
| | - Greet Van den Berghe
- Clinical Division and Laboratory of Intensive Care Medicine, Academic Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, B-3000, Leuven, Belgium
| | - Geert Meyfroidt
- Clinical Division and Laboratory of Intensive Care Medicine, Academic Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, B-3000, Leuven, Belgium.
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Simonov M, Ugwuowo U, Moreira E, Yamamoto Y, Biswas A, Martin M, Testani J, Wilson FP. A simple real-time model for predicting acute kidney injury in hospitalized patients in the US: A descriptive modeling study. PLoS Med 2019; 16:e1002861. [PMID: 31306408 PMCID: PMC6629054 DOI: 10.1371/journal.pmed.1002861] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 06/21/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is an adverse event that carries significant morbidity. Given that interventions after AKI occurrence have poor performance, there is substantial interest in prediction of AKI prior to its diagnosis. However, integration of real-time prognostic modeling into the electronic health record (EHR) has been challenging, as complex models increase the risk of error and complicate deployment. Our goal in this study was to create an implementable predictive model to accurately predict AKI in hospitalized patients and could be easily integrated within an existing EHR system. METHODS AND FINDINGS We performed a retrospective analysis looking at data of 169,859 hospitalized adults admitted to one of three study hospitals in the United States (in New Haven and Bridgeport, Connecticut) from December 2012 to February 2016. Demographics, medical comorbidities, hospital procedures, medications, and laboratory data were used to develop a model to predict AKI within 24 hours of a given observation. Outcomes of AKI severity, requirement for renal replacement therapy, and mortality were also measured and predicted. Models were trained using discrete-time logistic regression in a subset of Hospital 1, internally validated in the remainder of Hospital 1, and externally validated in Hospital 2 and Hospital 3. Model performance was assessed via the area under the receiver-operator characteristic (ROC) curve (AUC). The training set cohort contained 60,701 patients, and the internal validation set contained 30,599 patients. External validation data sets contained 43,534 and 35,025 patients. Patients in the overall cohort were generally older (median age ranging from 61 to 68 across hospitals); 44%-49% were male, 16%-20% were black, and 23%-29% were admitted to surgical wards. In the training set and external validation set, 19.1% and 18.9% of patients, respectively, developed AKI. The full model, including all covariates, had good ability to predict imminent AKI for the validation set, sustained AKI, dialysis, and death with AUCs of 0.74 (95% CI 0.73-0.74), 0.77 (95% CI 0.76-0.78), 0.79 (95% CI 0.73-0.85), and 0.69 (95% CI 0.67-0.72), respectively. A simple model using only readily available, time-updated laboratory values had very similar predictive performance to the complete model. The main limitation of this study is that it is observational in nature; thus, we are unable to conclude a causal relationship between covariates and AKI and do not provide an optimal treatment strategy for those predicted to develop AKI. CONCLUSIONS In this study, we observed that a simple model using readily available laboratory data could be developed to predict imminent AKI with good discrimination. This model may lend itself well to integration into the EHR without sacrificing the performance seen in more complex models.
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Affiliation(s)
- Michael Simonov
- Program of Applied Translational Research, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Ugochukwu Ugwuowo
- Program of Applied Translational Research, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Erica Moreira
- Joint Data Analytics Team, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Yu Yamamoto
- Program of Applied Translational Research, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Aditya Biswas
- Program of Applied Translational Research, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Melissa Martin
- Program of Applied Translational Research, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Jeffrey Testani
- Section of Cardiology, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - F. Perry Wilson
- Program of Applied Translational Research, Yale School of Medicine, New Haven, Connecticut, United States of America
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Han C, Lee YK, Park HC, Cho A, Choi SR, Yoon JW, Koo JR, Kim HJ, Noh JW, Park MJ. Serum alkaline phosphatase and γ-glutamyl transferase in acute pyelonephritis. Kidney Res Clin Pract 2019; 38:205-211. [PMID: 30841691 PMCID: PMC6577211 DOI: 10.23876/j.krcp.18.0074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 12/13/2018] [Accepted: 01/07/2019] [Indexed: 11/30/2022] Open
Abstract
Background Elevated serum alkaline phosphatase (AP) and γ-glutamyl transferase (γ-GT) are commonly observed in patients with acute pyelonephritis. The goal of this study was to examine the clinical significance of elevated serum AP and γ-GT levels and to explore the mechanisms underlying these changes. Methods We examined serum AP and γ-GT levels in 438 patients with acute pyelonephritis. Urine AP/creatinine (Cr), urine γ-GT/Cr, fractional excretion of AP, and fractional excretion of γ-GT (FEγ-GT) were evaluated in patients with elevated and normal serum levels. AP isoenzymes were also examined. Results We identified 77 patients (17.6%) with elevated serum AP and 134 patients (30.6%) with elevated serum γ-GT. Among them, both enzymes were elevated in 64 patients (14.6%). Older age, longer hospital stay, elevated baseline serum Cr, and complicated pyelonephritis were associated with increases in serum AP and γ-GT. Multivariate analysis showed that high serum AP levels were significantly correlated with renal impairment (odds ratio, 2.13; 95% confidence interval, 1.08–4.19; P = 0.029). FEγ-GT was significantly lower in patients with elevated serum enzyme levels. The liver fraction for AP isoenzyme profile did not increase in patients with elevated serum AP. Conclusion Our results demonstrated that elevated serum AP and γ-GT levels are associated with complicated pyelonephritis and renal impairment. Lower FEγ-GT levels in patients with elevated serum enzymes may be the result of decreased urinary excretion of these enzymes.
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Affiliation(s)
- Chaehoon Han
- Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Korea
| | - Young-Ki Lee
- Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Korea
| | - Hayne Cho Park
- Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Korea
| | - Ajin Cho
- Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Korea
| | - Sun Ryoung Choi
- Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Korea
| | - Jong-Woo Yoon
- Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Korea
| | - Ja Ryong Koo
- Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Korea
| | - Hyung Jik Kim
- Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Korea
| | - Jung-Woo Noh
- Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Korea
| | - Min-Jeong Park
- Department of Laboratory Medicine, Hallym University College of Medicine, Seoul, Korea
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Acute kidney injury following left ventricular assist device implantation: Contemporary insights and future perspectives. J Heart Lung Transplant 2019; 38:797-805. [PMID: 31352996 DOI: 10.1016/j.healun.2019.06.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 05/24/2019] [Accepted: 06/11/2019] [Indexed: 12/16/2022] Open
Abstract
Currently, an increasing number of patients with end-stage heart failure are being treated with left ventricular assist device (LVAD) therapy as bridge-to-transplantation, bridge-to-candidacy, or destination therapy (DT). Potential life-threatening complications may occur, specifically in the early post-operative phase, which positions LVAD implantation as a high-risk surgical procedure. Acute kidney injury (AKI) is a frequently observed complication after LVAD implantation and is associated with high morbidity and mortality. The rapidly growing number of LVAD implantations necessitates better approaches of identifying high-risk patients, optimizing peri-operative management, and preventing severe complications such as AKI. This holds especially true for those patients receiving an LVAD as DT, who are typically older (with higher burden of comorbidities) with impaired renal function and at increased post-operative risk. Herein we outline the definition, diagnosis, frequency, pathophysiology, and risk factors for AKI in patients with an LVAD. We also review possible strategies to prevent and manage AKI in this patient population.
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Chen Y, Harty GJ, Zheng Y, Iyer SR, Sugihara S, Sangaralingham SJ, Ichiki T, Grande JP, Lee HC, Wang XL, Burnett JC. CRRL269. Circ Res 2019; 124:1462-1472. [PMID: 30929579 PMCID: PMC6512967 DOI: 10.1161/circresaha.118.314164] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
RATIONALE Acute kidney injury (AKI) has a high prevalence and mortality in critically ill patients. It is also a powerful risk factor for heart failure incidence driven by hemodynamic changes and neurohormonal activation. However, no drugs have been approved by the Food and Drug Administration. Endogenous pGC-A (particulate guanylyl cyclase A receptor) activators were reported to preserve renal function and improve mortality in AKI patients, although hypotension accompanied by pGC-A activators have limited their therapeutic potential. OBJECTIVE We investigated the therapeutic potential of a nonhypotensive pGC-A activator/designer natriuretic peptide, CRRL269, in a short-term, large animal model of ischemia-induced AKI and also investigated the potential of uCNP (urinary C-type natriuretic peptide) as a biomarker for AKI. METHODS AND RESULTS We first showed that CRRL269 stimulated cGMP generation, suppressed plasma angiotensin II, and reduced cardiac filling pressures without lowering blood pressure in the AKI canine model. We also demonstrated that CRRL269 preserved glomerular filtration rate, increased renal blood flow, and promoted diuresis and natriuresis. Further, CRRL269 reduced kidney injury and apoptosis as evidenced by ex vivo histology and tissue apoptosis analysis. We also showed, compared with native pGC-A activators, that CRRL269 is a more potent inhibitor of apoptosis in renal cells and induced less decreases in intracellular Ca2+ concentration in vascular smooth muscle cells. The renal antiapoptotic effects were at least mediated by cGMP/PKG pathway. Further, CRRL269 inhibited proapoptotic genes expression using a polymerase chain reaction gene array. Additionally, we demonstrated that AKI increased uCNP levels. CONCLUSIONS Our study supports developing CRRL269 as a novel renocardiac protective agent for AKI treatment.
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Affiliation(s)
- Yang Chen
- Cardiorenal Research Laboratory, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN
| | - Gail J. Harty
- Cardiorenal Research Laboratory, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Ye Zheng
- Cardiorenal Research Laboratory, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Seethalakshmi R. Iyer
- Cardiorenal Research Laboratory, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Shinobu Sugihara
- Cardiorenal Research Laboratory, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - S. Jeson Sangaralingham
- Cardiorenal Research Laboratory, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN
| | - Tomoko Ichiki
- Cardiorenal Research Laboratory, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Joseph P. Grande
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Hon-Chi Lee
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Xiao Li Wang
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - John C. Burnett
- Cardiorenal Research Laboratory, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN
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Xu Z, Feng Y, Li Y, Srivastava A, Adekkanattu P, Ancker JS, Jiang G, Kiefer RC, Lee K, Pacheco JA, Rasmussen LV, Pathak J, Luo Y, Wang F. Predictive Modeling of the Risk of Acute Kidney Injury in Critical Care: A Systematic Investigation of The Class Imbalance Problem. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE PROCEEDINGS. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE 2019; 2019:809-818. [PMID: 31259038 PMCID: PMC6568062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Acute Kidney Injury (AKI) in critical care is often a quickly-evolving clinical event with high morbidity and mortality. Early prediction of AKI risk in critical care setting can facilitate early interventions that are likely to provide ben- efit. Recently there have been some research on AKI prediction with patient Electronic Health Records (EHR). The class imbalance problem is encountered in such prediction setting where the number of AKI cases is usually much smaller than the controls. This study systematically investigates the impact of class imbalance on the performance of AKI prediction. We systematically investigate several class-balancing strategies to address class imbalance, includ- ing traditional statistical approaches and the proposed methods (case-control matching approach and individualized prediction approach). Our results show that the proposed class-balancing strategies can effectively improve the AKI prediction performance. Additionally, some important predictors (e.g., creatinine, chloride, and urine) for AKI can be found based on the proposed methods.
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Affiliation(s)
- Zhenxing Xu
- Weill Cornell Medicine, Cornell University, New York, NY, USA
- Co-first authors, equal contribution
| | - Yujuan Feng
- Department of Computer Science and Engineering, Tsinghua University, Beijing, China
- Co-first authors, equal contribution
| | - Yun Li
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Anand Srivastava
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | | | - Kathleen Lee
- Weill Cornell Medicine, Cornell University, New York, NY, USA
| | | | - Luke V Rasmussen
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Yuan Luo
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Corresponding Authors
| | - Fei Wang
- Weill Cornell Medicine, Cornell University, New York, NY, USA
- Corresponding Authors
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Schlossbauer MH, Hubauer U, Stadler S, Hupf J, Sag S, Birner C, Zimmermann M, Orso E, Fischer M, Luchner A, Maier LS, Jungbauer CG. The role of the tubular biomarkers NAG, kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin in patients with chest pain before contrast media exposition. Biomark Med 2019; 13:379-392. [PMID: 30920848 DOI: 10.2217/bmm-2018-0275] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Aim: We evaluated the role of the tubular biomarkers N-acetyl-ß-D-glucosaminidase (NAG), kidney injury molecule-1 (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL) in patients with chest pain. Methods: Serum and urine samples were collected of 223 patients and 47 healthy controls. None of them was exposed to contrast media. Results: NAG showed among others significant correlation with N-terminal pro brain natriuretic peptide (NTproBNP), troponin I and creatinine. KIM-1 and NGAL showed weaker correlations. NAG was significantly elevated in all subgroups of acute coronary syndrome (ACS) compared with chest wall syndrome and controls. NAG was an independent predictor for the diagnosis of myocardial infarction. Conclusion: NAG may demonstrate the presence of acute tubular injury due to cardiac impairment already in the emergency department. NAG should be evaluated as marker of acute cardiorenal syndrome in patients with chest pain.
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Affiliation(s)
- Michael H Schlossbauer
- Abteilung für Kardiologie, Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Ute Hubauer
- Abteilung für Kardiologie, Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Stefan Stadler
- Abteilung für Kardiologie, Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Julian Hupf
- Abteilung für Kardiologie, Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Sabine Sag
- Abteilung für Kardiologie, Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Christoph Birner
- Abteilung für Kardiologie, Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Markus Zimmermann
- Interdisziplinäre Notaufnahme Universitätsklinikum Regensburg, Regensburg, Germany
| | - Evelyn Orso
- Klinische Chemie und Laboratoriumsmedizin, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Marcus Fischer
- Abteilung für Kardiologie, Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Andreas Luchner
- Abteilung für Kardiologie, Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Lars S Maier
- Abteilung für Kardiologie, Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Carsten G Jungbauer
- Abteilung für Kardiologie, Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
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Chun K, Chung W, Kim AJ, Kim H, Ro H, Chang JH, Lee HH, Jung JY. Association between acute kidney injury and serum procalcitonin levels and their diagnostic usefulness in critically ill patients. Sci Rep 2019; 9:4777. [PMID: 30886220 PMCID: PMC6423019 DOI: 10.1038/s41598-019-41291-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 03/04/2019] [Indexed: 12/14/2022] Open
Abstract
Procalcitonin (PCT) is a useful marker for the diagnosis of systemic inflammatory response syndrome. In addition, PCT is affected by renal function. However, few studies have investigated the relationship between PCT and the development of acute kidney injury (AKI). Hence, we investigated whether serum PCT levels at the time of admission were associated with the development of AKI and clinical outcomes. A total of 790 patients in whom PCT was measured on admission to the intensive care unit (ICU) were analyzed retrospectively. We attempted to investigate whether serum PCT levels measured at the time of admission could be used as a risk factor for the development of AKI in septic and nonseptic patients or as a risk factor for all-cause mortality, and diagnostic usefulness of PCT was further assessed. Serum PCT levels were significantly higher in patients with AKI than in those without AKI (P < 0.001). After multivariable adjustment for clinical factors, laboratory findings, and comorbidities, PCT as a continuous variable showed a significant association with AKI (OR 1.006, 95% CI [1.000–1.011]; P = 0.035). However, PCT was not effective in predicting mortality. The cut-off value of PCT for the prediction of AKI incidence was calculated to be 0.315 ng/ml, with sensitivity and specificity of 60.9% and 56.9%, respectively. The odds ratios (ORs) from an equation adjusted for optimum thresholds of PCT levels for developing AKI with and without sepsis were 2.422 (1.222–4.802, P = 0.011) and 1.798 (1.101–2.937, P = 0.019), respectively. However, there were no absolute differences between the pre- and posttest probabilities after including the PCT value for AKI development. This study suggests that the PCT value was higher in AKI patients than in non-AKI patients, but PCT measurement at the time of admission did not improve the prediction model for AKI.
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Affiliation(s)
- Kayeong Chun
- Division of Nephrology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Wookyung Chung
- Division of Nephrology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea.,Gachon University College of Medicine, Incheon, Korea
| | - Ae Jin Kim
- Division of Nephrology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea.,Gachon University College of Medicine, Incheon, Korea
| | - Hyunsook Kim
- Gachon Medical Research Institute, Incheon, Korea
| | - Han Ro
- Division of Nephrology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea.,Gachon University College of Medicine, Incheon, Korea
| | - Jae Hyun Chang
- Division of Nephrology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea.,Gachon University College of Medicine, Incheon, Korea
| | - Hyun Hee Lee
- Division of Nephrology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea.,Gachon University College of Medicine, Incheon, Korea
| | - Ji Yong Jung
- Division of Nephrology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea. .,Gachon University College of Medicine, Incheon, Korea. .,Gachon Medical Research Institute, Incheon, Korea.
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Brown JR, Thiessen-Philbrook H, Goodrich CA, Bohm AR, Alam SS, Coca SG, McArthur E, Garg AX, Parikh CR. Are Urinary Biomarkers Better Than Acute Kidney Injury Duration for Predicting Readmission? Ann Thorac Surg 2019; 107:1699-1705. [PMID: 30880140 DOI: 10.1016/j.athoracsur.2019.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 01/10/2019] [Accepted: 02/04/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) is a common complication of cardiac surgery. Postprocedural AKI is a risk factor for 30-day readmission. We sought to examine the association of AKI and kidney injury biomarkers with readmission after cardiac surgery. METHODS Patients alive at discharge who underwent cardiac surgery from the Translational Research Investigating Biomarker Endpoints-AKI cohort were enrolled from six medical centers in the United States and Canada. AKI duration was defined as the total number of days AKI was present during index admission (no AKI, 1-2, 3-6, and 7+ days). Preoperative and postoperative urinary levels were collected for interleukin-18, neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, liver-fatty-acid-binding protein, cystatin C, microalbumin, creatinine, and albumin-to-creatinine ratio. Readmission and death events were identified through US (Medicare) and Canadian administrative databases at 30 days and 365 days after discharge. RESULTS Of 968 patients 15.9% were readmitted or died within 30 days of discharge and 35.9% were readmitted or died within 365 days. AKI duration of 3 to 6 days was significantly associated with 30-day readmission or death (adjusted odds ratio, 1.82%; 95% confidence interval, 1.08-3.05). Patients with AKI duration ≥ 7 days had increased odds of readmission or death at both 30 days (adjusted odds ratio, 2.49%; 95% confidence interval, 1.15-5.43) and 365 days (adjusted odds ratio, 3.67%; 95% confidence interval, 1.73-7.79). Urinary biomarkers had no association with readmission and death. CONCLUSIONS AKI duration ≥ 3 days, and not kidney biomarkers, was strongly associated with readmission or death. These clinical outcomes are potentially due to cardiovascular or hemodynamic causes rather than intrinsic injury to the kidney parenchyma.
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Affiliation(s)
- Jeremiah R Brown
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, New Hampshire; Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
| | | | - Christine A Goodrich
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, New Hampshire
| | - Andrew R Bohm
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, New Hampshire
| | - Shama S Alam
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, New Hampshire
| | - Steven G Coca
- Division of Nephrology, Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Eric McArthur
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Amit X Garg
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Chirag R Parikh
- Division of Nephrology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
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Urinary N-acetyl-beta-d-glucosaminidase (NAG) with neutrophil gelatinase-associated lipocalin (NGAL) improves the diagnostic value for proximal tubule damage in diabetic kidney disease. 3 Biotech 2019; 9:66. [PMID: 30729090 DOI: 10.1007/s13205-019-1593-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 01/23/2019] [Indexed: 12/14/2022] Open
Abstract
Screening for diabetic kidney disease (DKD) remains a challenge; however, there has been an ongoing research to investigate the diagnostic value of different biomarkers to identify DKD. The aim of this study was to assess the diagnostic value of both N-acetyl-beta-d-glucosaminidase (NAG) and neutrophil gelatinase-associated lipocalin (NGAL) in the progression of DKD. This cross-sectional case-control study included 92 type 2 diabetic patients with or without DKD. Urinary NAG and NGAL were measured to evaluate their diagnostic values as biochemical markers related to DKD. Both urinary NAG and NGAL levels were significantly higher among patients with DKD. In multiple linear regression analysis, NAG showed a positive significant association with NGAL in the three different adjusted models, while no significant correlation with fasting blood glucose, glycated hemoglobin, serum creatinine, estimated glomerular filtration rate, and albumin creatinine ratio were observed. The area under the curve for NGAL was 0.659 (p = 0.01) and 0.564 (p = 0.297) for NAG in DKD patients. This study demonstrates the association between urinary NAG and NGAL as a tubular damage marker for DKD although longitudinal studies are needed to evaluate its diagnostic value.
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Gebremichael Y, Lu J, Shankaran H, Helmlinger G, Mettetal J, Hallow KM. Multiscale Mathematical Model of Drug-Induced Proximal Tubule Injury: Linking Urinary Biomarkers to Epithelial Cell Injury and Renal Dysfunction. Toxicol Sci 2019; 162:200-211. [PMID: 29126144 DOI: 10.1093/toxsci/kfx239] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Drug-induced nephrotoxicity is a major cause of acute kidney injury, and thus detecting the potential for nephrotoxicity early in the drug development process is critical. Various urinary biomarkers exhibit different patterns following drug-induced injury, which may provide greater information than traditional biomarkers like serum creatinine. In this study, we developed a multiscale quantitative systems pharmacology model relating drug exposure to proximal tubule (PT) epithelial cell injury and subsequently to expression of multiple urinary biomarkers and organ-level functional changes. We utilized urinary kidney injury molecule-1 (Kim-1), alpha glutathione S-transferase, albumin (αGST), glucose, and urine volume time profiles as well as serum creatinine and histopathology data obtained from rats treated with the nephrotoxicant cisplatin to develop the model. Although the model was developed using single-dose response to cisplatin, the model predicted the serum creatinine response to multidose cisplatin regimens. Further, using only the urinary Kim-1 response to gentamicin (a nephrotoxicant with a distinctly different injury time course than cisplatin), the model detected and predicted mild to moderate PT injury, as confirmed with histopathology, even when serum creatinine was unchanged. Thus, the model is generalizable, and can be used to deconvolute the underlying degree and time course of drug-induced PT injury and renal dysfunction from a small number of urinary biomarkers, and may provide a tool to determine optimal dosing regimens that minimize renal injury.
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Affiliation(s)
- Yeshitila Gebremichael
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, Georgia
| | - James Lu
- IMED Biotech Unit, Astrazeneca Pharmaceuticals, Cambridge, UK
| | - Harish Shankaran
- IMED Biotech Unit, Astrazeneca Pharmaceuticals, Waltham, Massachusetts
| | | | - Jerome Mettetal
- IMED Biotech Unit, Astrazeneca Pharmaceuticals, Waltham, Massachusetts
| | - K Melissa Hallow
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, Georgia
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Zimmerman LP, Reyfman PA, Smith ADR, Zeng Z, Kho A, Sanchez-Pinto LN, Luo Y. Early prediction of acute kidney injury following ICU admission using a multivariate panel of physiological measurements. BMC Med Inform Decis Mak 2019; 19:16. [PMID: 30700291 PMCID: PMC6354330 DOI: 10.1186/s12911-019-0733-z] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The development of acute kidney injury (AKI) during an intensive care unit (ICU) admission is associated with increased morbidity and mortality. METHODS Our objective was to develop and validate a data driven multivariable clinical predictive model for early detection of AKI among a large cohort of adult critical care patients. We utilized data form the Medical Information Mart for Intensive Care III (MIMIC-III) for all patients who had a creatinine measured for 3 days following ICU admission and excluded patients with pre-existing condition of Chronic Kidney Disease and Acute Kidney Injury on admission. Data extracted included patient age, gender, ethnicity, creatinine, other vital signs and lab values during the first day of ICU admission, whether the patient was mechanically ventilated during the first day of ICU admission, and the hourly rate of urine output during the first day of ICU admission. RESULTS Utilizing the demographics, the clinical data and the laboratory test measurements from Day 1 of ICU admission, we accurately predicted max serum creatinine level during Day 2 and Day 3 with a root mean square error of 0.224 mg/dL. We demonstrated that using machine learning models (multivariate logistic regression, random forest and artificial neural networks) with demographics and physiologic features can predict AKI onset as defined by the current clinical guideline with a competitive AUC (mean AUC 0.783 by our all-feature, logistic-regression model), while previous models aimed at more specific patient cohorts. CONCLUSIONS Experimental results suggest that our model has the potential to assist clinicians in identifying patients at greater risk of new onset of AKI in critical care setting. Prospective trials with independent model training and external validation cohorts are needed to further evaluate the clinical utility of this approach and potentially instituting interventions to decrease the likelihood of developing AKI.
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Affiliation(s)
| | | | | | - Zexian Zeng
- Northwestern University, Evanston, IL 60208 USA
| | - Abel Kho
- Northwestern University, Evanston, IL 60208 USA
| | | | - Yuan Luo
- Northwestern University, Evanston, IL 60208 USA
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Khan S, Mahmood W. Evaluation of the Effect of Atenolol Induced Depression in Cardiac Output on Its Own Excretion through Urine Analysis. IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH : IJPR 2019; 18:523-530. [PMID: 31089386 PMCID: PMC6487397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The role of Pharmacist in making the therapeutic decisions for safe and effective therapy is increasing all over the world. However, there are many aspects of drugs in making these decisions that are less commonly studied such as the correlation of cardiac output with pharmacokinetics of drugs. The cardiac output, besides the other factors, is also affected by drugs like atenolol. Therefore, the objective of the present open labeled study was to know the effect of reduced cardiac output induced by atenolol on its own excretion parameters. After taking the informed consent, five healthy volunteers were selected for the study. Atenolol tablet at a dose of 50 mg, 75 mg and 100 mg for three consecutive days were given to all the volunteers. The echocardiography and renal function clinical tests were conducted prior and 5 h after dosing and the urine samples were collected at 5 and 10 h post dosing. The prepared samples were analyzed for atenolol by High-Performance Liquid chromatography. For comparison of atenolol excretion for three days, One-way repeated measure Analysis of Variance statistical test was used as Wilks' Lambda = 0.2, F (2, 3) = 5.986, p < 0.1, multivariate partial squared = 0.8. These results showed that atenolol affects its own pharmacokinetics by prolonging its excretion half-life.
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Kim WH, Lee HC, Lim L, Ryu HG, Jung CW. Intraoperative Oliguria with Decreased SvO₂ Predicts Acute Kidney Injury after Living Donor Liver Transplantation. J Clin Med 2018; 8:jcm8010029. [PMID: 30597881 PMCID: PMC6351957 DOI: 10.3390/jcm8010029] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 12/17/2018] [Accepted: 12/24/2018] [Indexed: 12/14/2022] Open
Abstract
Acute kidney injury (AKI) is a frequent complication after living donor liver transplantation (LDLT), and is associated with increased mortality. However, the association between intraoperative oliguria and the risk of AKI remains uncertain for LDLT. We sought to determine the association between intraoperative oliguria alone and oliguria coupled with hemodynamic derangement and the risk of AKI after LDLT. We evaluated the hemodynamic variables, including mean arterial pressure, cardiac index, and mixed venous oxygen saturation (SvO2). We reviewed 583 adult patients without baseline renal dysfunction and who did not receive hydroxyethyl starch during surgery. AKI was defined using the Kidney Disease Improving Global Outcomes criteria according to the serum creatinine criteria. Multivariable logistic regression analysis was performed with and without oliguria and oliguria coupled with a decrease in SvO2. The performance was compared with respect to the area under the receiver operating characteristic curve (AUC). Intraoperative oliguria <0.5 and <0.3 mL/kg/h were significantly associated with the risk of AKI; however, their performance in predicting AKI was poor. The AUC of single predictors increased significantly when oliguria was combined with decreased SvO2 (AUC 0.72; 95% confidence interval (CI) 0.68–0.75 vs. AUC of oliguria alone 0.61; 95% CI 0.56–0.61; p < 0.0001; vs. AUC of SvO2 alone 0.66; 95% CI 0.61–0.70; p < 0.0001). Addition of oliguria coupled with SvO2 reduction also increased the AUC of multivariable prediction (AUC 0.87; 95% CI 0.84–0.90 vs. AUC with oliguria 0.73; 95% CI 0.69–0.77; p < 0.0001; vs. AUC with neither oliguria nor SvO2 reduction 0.68; 95% CI 0.64–0.72; p < 0.0001). Intraoperative oliguria coupled with a decrease in SvO2 may suggest the risk of AKI after LDLT more reliably than oliguria alone or decrease in SvO2 alone. Intraoperative oliguria should be interpreted in conjunction with SvO2 to predict AKI in patients with normal preoperative renal function and who did not receive hydroxyethyl starch during surgery.
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Affiliation(s)
- Won Ho Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul 03080, Korea.
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul 03080, Korea.
| | - Hyung-Chul Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul 03080, Korea.
| | - Leerang Lim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul 03080, Korea.
| | - Ho-Geol Ryu
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul 03080, Korea.
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul 03080, Korea.
| | - Chul-Woo Jung
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul 03080, Korea.
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul 03080, Korea.
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Li Y, Yao L, Mao C, Srivastava A, Jiang X, Luo Y. Early Prediction of Acute Kidney Injury in Critical Care Setting Using Clinical Notes. PROCEEDINGS. IEEE INTERNATIONAL CONFERENCE ON BIOINFORMATICS AND BIOMEDICINE 2018; 2018:683-686. [PMID: 33376624 PMCID: PMC7768909 DOI: 10.1109/bibm.2018.8621574] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Acute kidney injury (AKI) in critically ill patients is associated with significant morbidity and mortality. Development of novel methods to identify patients with AKI earlier will allow for testing of novel strategies to prevent or reduce the complications of AKI. We developed data-driven prediction models to estimate the risk of new AKI onset. We generated models from clinical notes within the first 24 hours following intensive care unit (ICU) admission extracted from Medical Information Mart for Intensive Care III (MIMIC-III). From the clinical notes, we generated clinically meaningful word and concept representations and embeddings, respectively. Five supervised learning classifiers and knowledge-guided deep learning architecture were used to construct prediction models. The best configuration yielded a competitive AUC of 0.779. Our work suggests that natural language processing of clinical notes can be applied to assist clinicians in identifying the risk of incident AKI onset in critically ill patients upon admission to the ICU.
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Affiliation(s)
- Yikuan Li
- Dept. of EECS, Northwestern University, Evanston, IL, U.S.A
| | | | - Chengsheng Mao
- Dept. of Preventive Medicine, Northwestern University, Chicago, IL, U.S.A
| | - Anand Srivastava
- Div. of Nephrology and Hypertension, Northwestern University, Chicago, IL, U.S.A
| | - Xiaoqian Jiang
- School of Biomedical Informatics, Univ. of Texas Health Science Center, Houston, TX, U.S.A
| | - Yuan Luo
- Dept. of Preventive Medicine, Northwestern University, Chicago, IL, U.S.A
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Zhang Z, Gao Y, Qiao X. WITHDRAWN: Spleen tyrosine kinase (SYK) protects renal tubular epithelial cell against hypoxia injury in children with acute kidney injury. Gene 2018:S0378-1119(18)31156-9. [PMID: 30408549 DOI: 10.1016/j.gene.2018.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 03/13/2018] [Accepted: 11/03/2018] [Indexed: 11/21/2022]
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Affiliation(s)
- Zhiyong Zhang
- Medicine School of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China
| | - Ya Gao
- Department of Pediatric Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi, China.
| | - Ximin Qiao
- Central Hospital of Xianyang, Xianyang 712000, Shaanxi, China
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Wyler von Ballmoos M, Likosky DS, Rezaee M, Lobdell K, Alam S, Parker D, Owens S, Thiessen-Philbrook H, MacKenzie T, Brown JR. Elevated preoperative Galectin-3 is associated with acute kidney injury after cardiac surgery. BMC Nephrol 2018; 19:280. [PMID: 30342486 PMCID: PMC6195960 DOI: 10.1186/s12882-018-1093-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 10/09/2018] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Previous research suggests that novel biomarkers may be used to identify patients at increased risk of acute kidney injury following cardiac surgery. The purpose of this study was to evaluate the relationship between preoperative levels of circulating Galectin-3 (Gal-3) and acute kidney injury after cardiac surgery. METHODS Preoperative serum Gal-3 was measured in 1498 patients who underwent coronary artery bypass graft (CABG) surgery and/or valve surgery as part of the Northern New England Biomarker Study between 2004 and 2007. Preoperative Gal-3 levels were measured using multiplex assays and grouped into terciles. Univariate and multinomial logistic regression was used to assess the predictive ability of Gal-3 terciles and AKI occurrence and severity. RESULTS Before adjustment, patients in the highest tercile of Gal-3 had a 2.86-greater odds of developing postoperative KDIGO Stage 2 or 3 (p < 0.001) and 1.70-greater odds of developing KDIGO Stage 1 (p = < 0.001), compared to the first tercile. After adjustment, patients in the highest tercile had 2.95-greater odds of developing KDIGO Stage 2 or 3 (p < 0.001) and 1.71-increased odds of developing KDIGO Stage 1 (p = 0.001), compared to the first tercile. Compared to the base model, the addition of Gal-3 terciles improved discriminatory power compared to without Gal-3 terciles (test of equality = 0.042). CONCLUSION Elevated preoperative Gal-3 levels significantly improves predictive ability over existing clinical models for postoperative AKI and may be used to augment risk information for patients at the highest risk of developing AKI and AKI severity after cardiac surgery.
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Affiliation(s)
| | - Donald S. Likosky
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI USA
- Section of Health Services Research and Quality, Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI USA
| | - Michael Rezaee
- Section of Urology, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH USA
| | | | - Shama Alam
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH USA
| | - Devin Parker
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH USA
| | - Sherry Owens
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH USA
| | | | - Todd MacKenzie
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH USA
- Department of Biomedical Data Science, HB 7505 Dartmouth-Hitchcock Medical Center, Lebanon, NH NH 03756 USA
| | - Jeremiah R. Brown
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH USA
- Department of Biomedical Data Science, HB 7505 Dartmouth-Hitchcock Medical Center, Lebanon, NH NH 03756 USA
- Department of Epidemiology, Geisel School of Medicine, Lebanon, NH USA
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Teo SH, Endre ZH. Biomarkers in acute kidney injury (AKI). Best Pract Res Clin Anaesthesiol 2018; 31:331-344. [PMID: 29248140 DOI: 10.1016/j.bpa.2017.10.003] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 10/25/2017] [Indexed: 12/14/2022]
Abstract
Acute kidney injury is common in critically ill patients and portends a significant impact on mortality, progressive chronic kidney disease, and cardiovascular disease and mortality. Though most physicians alter therapy depending on changes in serum creatinine, this often represents delayed intervention. Various AKI biomarkers have been discovered and validated to improve timely detection, differentiation and stratification into risk groups for progressive renal decline, need for renal replacement therapy or death. This chapter will review AKI biomarkers validated over the past decade. We also describe the clinical performance of the biomarkers. We suggest that using AKI biomarkers to complement serum creatinine (or cystatin C) and urine output will better integrate patient care through earlier recognition and clinical outcome prediction after AKI.
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Affiliation(s)
- Su Hooi Teo
- Department of Nephrology, Singapore General Hospital, Singapore
| | - Zoltán Huba Endre
- Department of Nephrology, Prince of Wales Hospital, High Street, Randwick, Sydney, 2031, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, Australia; Department of Medicine, University of Otago-Christchurch; Christchurch, New Zealand; School of Medicine, University of Queensland, Brisbane, Australia.
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Park N, Kang E, Park M, Lee H, Kang HG, Yoon HJ, Kang U. Predicting acute kidney injury in cancer patients using heterogeneous and irregular data. PLoS One 2018; 13:e0199839. [PMID: 30024918 PMCID: PMC6053162 DOI: 10.1371/journal.pone.0199839] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 06/14/2018] [Indexed: 12/22/2022] Open
Abstract
How can we predict the occurrence of acute kidney injury (AKI) in cancer patients based on machine learning with serum creatinine data? Given irregular and heterogeneous clinical data, how can we make the most of it for accurate AKI prediction? AKI is a common and significant complication in cancer patients, and correlates with substantial morbidity and mortality. Since no effective treatment for AKI still exists, it is important to take timely preventive measures. While several approaches have been proposed for predicting AKI, their scope and applicability are limited as they either assume regular data measured over a short hospital stay, or do not fully utilize heterogeneous data. In this paper, we provide an AKI prediction model with a greater applicability, which relaxes the constraints of existing approaches, and fully utilizes irregular and heterogeneous data for learning the model. In a cohort of 21,022 cancer patients who were registered into Korea Central Cancer Registry (KCCR) in Seoul National University Hospital between January 1, 2004 and December 31, 2013, our method achieves 0.7892 precision, 0.7506 recall, and 0.7576 F-measure in predicting whether a patient will develop AKI during the next 14 days.
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Affiliation(s)
- Namyong Park
- Department of Computer Science and Engineering, Seoul National University, Seoul, Republic of Korea
| | - Eunjeong Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Minsu Park
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hajeong Lee
- Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hee-Gyung Kang
- Pediatrics, Seoul National University Children’s Hospital, Seoul, Republic of Korea
| | - Hyung-Jin Yoon
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - U. Kang
- Department of Computer Science and Engineering, Seoul National University, Seoul, Republic of Korea
- * E-mail:
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Acute kidney injury after lung cancer surgery: Incidence and clinical relevance, predictors, and role of N-terminal pro B-type natriuretic peptide. Lung Cancer 2018; 123:155-159. [PMID: 30089588 DOI: 10.1016/j.lungcan.2018.07.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/25/2018] [Accepted: 07/07/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) frequently occurs in several medical and surgical settings, and it is associated with increased morbidity and mortality. In patients undergoing lung cancer surgery, AKI has not been fully investigated. We prospectively evaluated the incidence, clinical relevance, and risk factors of AKI in patients undergoing lung cancer surgery. Moreover, we estimated the accuracy of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in the prediction of AKI. METHODS Patients undergoing lung cancer surgery were included in the study. Plasma NT-proBNP was measured before and soon after surgery. Postoperative AKI was defined according to the Acute Kidney Injury Network (AKIN) classification. RESULTS A total of 2179 patients were enrolled. Of them, 222 (10%) developed AKI and had a more complicated in-hospital clinical course (overall complication rate: 35% vs. 16%; P < 0.0001), and a longer hospital stay (10 ± 7 vs. 7 ± 4 days; P < 0.0001). The incidence of AKI increased in parallel with the extent of lung resection. Among the independent predictors of AKI, serum creatinine (area under the curve [AUC] 0.70 [95% CI 0.67-0.74]) and NT-proBNP (AUC 0.71 [95% CI 0.67-0.74]) provided the highest predictive accuracy, and their combination further significantly improved AKI prediction (AUC 0.74 [95% CI 0.71-0.77]). No difference in AKI prediction was observed between preoperative and postoperative NT-proBNP (P = 0.84). CONCLUSIONS Acute kidney injury occurs in 10% of patients undergoing lung cancer surgery, and it is associated with a high incidence of postoperative complications. The risk of AKI can be accurately predicted by the combined evaluation of preoperative serum creatinine and NT-proBNP.
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