1
|
Martínez-Chillarón M, Cupich AL, Piñeiro GJ, Molina-Andújar A, Poch López de Briñas E. Furosemide responsiveness test-is there any reason to be afraid of diuretic use after cardiac surgery? J Thorac Dis 2024; 16:4825-4828. [PMID: 39144322 PMCID: PMC11320253 DOI: 10.21037/jtd-24-153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 05/31/2024] [Indexed: 08/16/2024]
Affiliation(s)
| | - Agustin Leal Cupich
- Nephrology and Kidney Transplantation Department, Hospital Clinic, Barcelona, Spain
| | - Gaston J. Piñeiro
- Nephrology and Kidney Transplantation Department, Hospital Clinic, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Alícia Molina-Andújar
- Nephrology and Kidney Transplantation Department, Hospital Clinic, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Esteban Poch López de Briñas
- Nephrology and Kidney Transplantation Department, Hospital Clinic, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| |
Collapse
|
2
|
Woo HY, An JM, Park MY, Han A, Kim Y, Kang J, Ahn S, Min SK, Ha J, Kim D, Min S. Cysteine as an Innovative Biomarker for Kidney Injury. Transplantation 2024:00007890-990000000-00828. [PMID: 39049125 DOI: 10.1097/tp.0000000000005138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
BACKGROUND Kidney transplantation is a widely used treatment for end-stage kidney disease. Nevertheless, the incidence of acute kidney injury (AKI) in deceased donors poses a potential hazard because it significantly increases the risk of delayed graft function and potentially exerts an influence on the kidney allograft outcome. It is crucial to develop a diagnostic model capable of assessing the existence and severity of AKI in renal grafts. However, no suitable kidney injury markers have been developed thus far. METHODS We evaluated the efficacy of the molecular probe NPO-B, which selectively responds to cysteine, as a new diagnostic tool for kidney injury. We used an in vitro model using ischemia/reperfusion injury human kidney-2 cells and an in vivo ischemia/reperfusion injury mouse model. Additionally, cysteine was investigated using urine samples from deceased donors and living donors to assess the applicability of detection techniques to humans. RESULTS This study confirmed that the NPO-B probe effectively identified and visualized the severity of kidney injury by detecting cysteine in both in vitro and in vivo models. We observed that the fluorescence intensity of urine samples measured using NPO-B from the deceased donors who are at a high risk of renal injury was significantly stronger than that of the living donors. CONCLUSIONS If implemented in clinical practice, this new diagnostic tool using NPO-B can potentially enhance the success rate of kidney transplantation by accurately determining the extent of AKI in renal grafts.
Collapse
Affiliation(s)
- Hye Young Woo
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jong Min An
- Department of Biomedical Science, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Min Young Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ahram Han
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Youngwoong Kim
- Department of Biomedical Science, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Jisoo Kang
- Department of Biomedical Science, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Sanghyun Ahn
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung-Kee Min
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jongwon Ha
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Dokyoung Kim
- Department of Biomedical Science, Graduate School, Kyung Hee University, Seoul, Republic of Korea
- Medical Research Center for Bioreaction to Reactive Oxygen Species and Biomedical Science Institute, Core Research Institute (CRI), Kyung Hee University, Seoul, Republic of Korea
- Department of Anatomy and Neurobiology, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
- Center for Converging Humanities, Kyung Hee University, Seoul, Republic of Korea
- KHU-KIST Department of Converging Science and Technology, Kyung Hee University, Seoul, Republic of Korea
- UC San Diego Materials Research Science and Engineering Center, La Jolla, CA
- Center for Brain Technology, Brain Science Institute, Korea Institute of Science and Technology, Seoul, Republic of Korea
- Department of Precision Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Sangil Min
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
3
|
Liu L, Hu Z. When to start renal replacement therapy in acute kidney injury: What are we waiting for? JOURNAL OF INTENSIVE MEDICINE 2024; 4:341-346. [PMID: 39035622 PMCID: PMC11258500 DOI: 10.1016/j.jointm.2023.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 12/11/2023] [Accepted: 12/15/2023] [Indexed: 07/23/2024]
Abstract
Acute kidney injury remains a serious condition with a high mortality risk. In the absence of any new drugs, renal replacement therapy (RRT) is the most important treatment option. Randomized controlled trials have concluded that in critically ill patients without an emergency indication for RRT, a watchful waiting strategy is safe; however, further delays in RRT did not seem to confer any benefit, rather was associated with potential harm. During this process, balancing the risks of complications due to an unnecessary intervention with the risk of not correcting a potentially life-threatening complication remains a challenge. Dynamic renal function assessment, especially dynamic assessment of renal demand-capacity matching, combined with renal biomarkers such as neutrophil gelatinase-associated lipocalin and furosemide stress test, is helpful to identify which patients and when the patients may benefit from RRT.
Collapse
Affiliation(s)
- Lixia Liu
- Department of Critical Care Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Zhenjie Hu
- Department of Critical Care Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| |
Collapse
|
4
|
Jeong R, Haines R, Ostermann M. Outcomes after acute kidney injury and critical illness. Curr Opin Crit Care 2024:00075198-990000000-00191. [PMID: 39092636 DOI: 10.1097/mcc.0000000000001183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
PURPOSE OF REVIEW Acute kidney injury (AKI) in critical illness is common, and survivors are faced with a host of adverse outcomes. In this article, we review the current landscape of outcomes and care in survivors of AKI and critical illness. RECENT FINDINGS Follow-up care of survivors of AKI and critical illness is prudent to monitor for and mitigate the risk of adverse outcomes. Observational data have suggested improvement in outcomes with nephrology-based follow-up care, and recent interventional studies demonstrate similar findings. However, current post-AKI care is suboptimal with various challenges, such as breakdowns in the transition of care during hospital episodes and into the community, barriers for patients in follow-up, and lack of identification of high-risk patients for nephrology-based follow-up. Tools predictive of renal nonrecovery and long-term outcomes may help to identify high-risk patients who may benefit the most from nephrology-based care post-AKI. SUMMARY Follow-up care of survivors of AKI and critical illness may improve outcomes and there is a need to prioritize transitions of care into the community. Further research is needed to elucidate the best ways to risk-stratify and manage post-AKI survivors to improve outcomes.
Collapse
Affiliation(s)
- Rachel Jeong
- Division of Nephrology, Department of Medicine
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
| | - Ryan Haines
- Department of Critical Care, King's College London, Guy's & St. Thomas' Hospital, King's College London, London, UK
| | - Marlies Ostermann
- Department of Critical Care, King's College London, Guy's & St. Thomas' Hospital, King's College London, London, UK
| |
Collapse
|
5
|
Su Y, Wang P, Hu Y, Liu WJ, Zhang YJ, Chen JQ, Deng YZ, Lin S, Qiu Y, Li JK, Chen C, Tu GW, Luo Z. AKI-Pro score for predicting progression to severe acute kidney injury or death in patients with early acute kidney injury after cardiac surgery. J Transl Med 2024; 22:571. [PMID: 38879493 PMCID: PMC11180399 DOI: 10.1186/s12967-024-05279-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 05/07/2024] [Indexed: 06/19/2024] Open
Abstract
BACKGROUND No reliable clinical tools exist to predict acute kidney injury (AKI) progression. We aim to explore a scoring system for predicting the composite outcome of progression to severe AKI or death within seven days among early AKI patients after cardiac surgery. METHODS In this study, we used two independent cohorts, and patients who experienced mild/moderate AKI within 48 h after cardiac surgery were enrolled. Eventually, 3188 patients from the MIMIC-IV database were used as the derivation cohort, while 499 patients from the Zhongshan cohort were used as external validation. The primary outcome was defined by the composite outcome of progression to severe AKI or death within seven days after enrollment. The variables identified by LASSO regression analysis were entered into logistic regression models and were used to construct the risk score. RESULTS The composite outcome accounted for 3.7% (n = 119) and 7.6% (n = 38) of the derivation and validation cohorts, respectively. Six predictors were assembled into a risk score (AKI-Pro score), including female, baseline eGFR, aortic surgery, modified furosemide responsiveness index (mFRI), SOFA, and AKI stage. And we stratified the risk score into four groups: low, moderate, high, and very high risk. The risk score displayed satisfied predictive discrimination and calibration in the derivation and validation cohort. The AKI-Pro score discriminated the composite outcome better than CRATE score, Cleveland score, AKICS score, Simplified renal index, and SRI risk score (all P < 0.05). CONCLUSIONS The AKI-Pro score is a new clinical tool that could assist clinicians to identify early AKI patients at high risk for AKI progression or death.
Collapse
Affiliation(s)
- Ying Su
- Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Peng Wang
- Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Yan Hu
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Wen-Jun Liu
- Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Yi-Jie Zhang
- Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Jia-Qi Chen
- Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Yi-Zhi Deng
- Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Shuang Lin
- Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Yue Qiu
- Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Jia-Kun Li
- Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Chen Chen
- Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Guo-Wei Tu
- Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China.
| | - Zhe Luo
- Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China.
- Shanghai Key Laboratory of Lung Inflammation and Injury, Shanghai, China.
- Department of Critical Care Medicine, Shanghai Xuhui Central Hospital, Zhongshan-Xuhui Hospital, Fudan University, Shanghai, China.
| |
Collapse
|
6
|
Claudel SE, Waikar SS. Systematic Review of Kidney Injury Biomarkers for the Evaluation of CKD of Uncertain Etiology. Kidney Int Rep 2024; 9:1614-1632. [PMID: 38899184 PMCID: PMC11184258 DOI: 10.1016/j.ekir.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 02/13/2024] [Accepted: 03/11/2024] [Indexed: 06/21/2024] Open
Abstract
Introduction Chronic kidney disease of uncertain etiology (CKDu) is an incompletely defined phenotype of chronic kidney disease (CKD) affecting young individuals mostly in agricultural communities in Central America and South Asia. CKDu is a diagnosis of exclusion made in individuals from endemic regions. Methods We conducted a systematic review of the primary literature on urinary and plasma kidney injury biomarkers measured in the setting of CKDu (through February 2023). The literature was identified via a Web of Science search and hand search of the references of previously identified literature. Search terms included "CKDu," "Mesoamerican Nephropathy," "CKD of unknown etiology," "Chronic Interstitial Nephritis in Agricultural Communities," "biomarker," "urin∗," and/or "plasma." Results A total of 25 papers were included. The 2 most frequently measured biomarkers were urinary kidney injury molecule-1 (KIM-1) and urinary neutrophil gelatinase-associated lipocalin (NGAL). There was substantial variability in study design, laboratory assay methods, and statistical methodology, which prohibited meta-analysis. Conclusion Biomarkers that identify tubulointerstitial disease early and accurately may substantially accelerate progress in the study of CKDu and facilitate public health approaches that eventually lead to its prevention and elimination. To date, the literature is limited by relatively small sample sizes and methodological limitations which should be addressed in future studies.
Collapse
Affiliation(s)
- Sophie E. Claudel
- Department of Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Sushrut S. Waikar
- Department of Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Section of Nephrology, Department of Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| |
Collapse
|
7
|
Scurt FG, Bose K, Mertens PR, Chatzikyrkou C, Herzog C. Cardiac Surgery-Associated Acute Kidney Injury. KIDNEY360 2024; 5:909-926. [PMID: 38689404 PMCID: PMC11219121 DOI: 10.34067/kid.0000000000000466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 04/26/2024] [Indexed: 05/02/2024]
Abstract
AKI is a common and serious complication of cardiac surgery that has a significant impact on patient morbidity and mortality. The Kidney Disease Improving Global Outcomes definition of AKI is widely used to classify and identify AKI associated with cardiac surgery (cardiac surgery-associated AKI [CSA-AKI]) on the basis of changes in serum creatinine and/or urine output. There are various preoperative, intraoperative, and postoperative risk factors for the development of CSA-AKI which should be recognized and addressed as early as possible to expedite its diagnosis, reduce its occurrence, and prevent or ameliorate its devastating complications. Crucial issues are the inaccuracy of serum creatinine as a surrogate parameter of kidney function in the perioperative setting of cardiothoracic surgery and the necessity to discover more representative markers of the pathophysiology of AKI. However, except for the tissue inhibitor of metalloproteinase-2 and insulin-like growth factor binding protein 7 ratio, other diagnostic biomarkers with an acceptable sensitivity and specificity are still lacking. This article provides a comprehensive review of various aspects of CSA-AKI, including pathogenesis, risk factors, diagnosis, biomarkers, classification, prevention, and treatment management.
Collapse
Affiliation(s)
- Florian G. Scurt
- Clinic of Nephrology, Hypertension, Diabetes and Endocrinology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Katrin Bose
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Magdeburg, Magdeburg, Germany
| | - Peter R. Mertens
- Clinic of Nephrology, Hypertension, Diabetes and Endocrinology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Christos Chatzikyrkou
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Carolin Herzog
- Clinic of Nephrology, Hypertension, Diabetes and Endocrinology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| |
Collapse
|
8
|
Gaggar P, Raju SB. Diagnostic Utility of Urine Microscopy in Kidney Diseases. Indian J Nephrol 2024; 34:213-221. [PMID: 39114391 PMCID: PMC11303840 DOI: 10.25259/ijn_362_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/03/2023] [Indexed: 08/10/2024] Open
Abstract
Urine sediment analysis is a highly valuable yet underutilized test in today's advanced medical landscape. The analysis of urine sediment is a simple, cost-effective, and powerful diagnostic tool in the hands of a skilled nephrologist, generally in all kidney diseases and particularly more so in the setting of acute kidney injury (AKI). The impact of AKI is far-reaching and encompasses elevated mortality rates, increased morbidity, longer hospital stays, and higher overall healthcare expenses. Timely and compartmental diagnosis of AKI with the use of a simple urine sediment analysis leads to targeted therapeutic strategies and also serves as a prognostic guide. The widespread use of automated analysis in recent times has its own set of limitations, as it fails to identify pathological casts, crystals, and dysmorphic red blood cells (RBCs). Hence, it is the need of the hour to learn this time-honored art of urine sediment analysis, to provide comprehensive patient care.
Collapse
Affiliation(s)
- Payal Gaggar
- Department of Nephrology, Medical Trust Hospital, Kochi, Kerala, India
| | - Sree B. Raju
- Department of Nephrology, NIMS, Hyderabad, Telangana, India
| |
Collapse
|
9
|
Singh R, Watchorn JC, Zarbock A, Forni LG. Prognostic Biomarkers and AKI: Potential to Enhance the Identification of Post-Operative Patients at Risk of Loss of Renal Function. Res Rep Urol 2024; 16:65-78. [PMID: 38476861 PMCID: PMC10928916 DOI: 10.2147/rru.s385856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 02/29/2024] [Indexed: 03/14/2024] Open
Abstract
Acute kidney injury (AKI) is a common complication after surgery and the more complex the surgery, the greater the risk. During surgery, patients are exposed to a combination of factors all of which are associated with the development of AKI. These include hypotension and hypovolaemia, sepsis, systemic inflammation, the use of nephrotoxic agents, tissue injury, the infusion of blood or blood products, ischaemia, oxidative stress and reperfusion injury. Given the risks of AKI, it would seem logical to conclude that early identification of patients at risk of AKI would translate into benefit. The conventional markers of AKI, namely serum creatinine and urine output are the mainstay of defining chronic kidney disease but are less suited to the acute phase. Such concerns are compounded in surgical patients given they often have significantly reduced mobility, suboptimal levels of nutrition and reduced muscle bulk. Many patients may also have misleadingly low serum creatinine and high urine output due to aggressive fluid resuscitation, particularly in intensive care units. Over the last two decades, considerable information has accrued with regard to the performance of what was termed "novel" biomarkers of AKI, and here, we discuss the most examined molecules and performance in surgical settings. We also discuss the application of biomarkers to guide patients' postoperative care.
Collapse
Affiliation(s)
- Rishabh Singh
- Department of Surgery, Royal Surrey Hospital, Guildford, Surrey, UK
| | - James C Watchorn
- Intensive Care Unit, Royal Berkshire NHS Foundation Trust, Reading, Berkshire, UK
| | - Alexander Zarbock
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Lui G Forni
- Critical Care Unit, Royal Surrey Hospital, Guildford, Surrey, UK
- School of Medicine, Kate Granger Building, University of Surrey, Guildford, UK
| |
Collapse
|
10
|
Romero-González G, Rodríguez-Chitiva N, Cañameras C, Paúl-Martínez J, Urrutia-Jou M, Troya M, Soler-Majoral J, Graterol Torres F, Sánchez-Bayá M, Calabia J, Bover J. Albuminuria, Forgotten No More: Underlining the Emerging Role in CardioRenal Crosstalk. J Clin Med 2024; 13:777. [PMID: 38337471 PMCID: PMC10856688 DOI: 10.3390/jcm13030777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/21/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
Kidneys have an amazing ability to adapt to adverse situations, both acute and chronic. In the presence of injury, the kidney is able to activate mechanisms such as autoregulation or glomerular hyperfiltration to maintain the glomerular filtration rate (GFR). While these adaptive mechanisms can occur in physiological situations such as pregnancy or high protein intake, they can also occur as an early manifestation of diseases such as diabetes mellitus or as an adaptive response to nephron loss. Although over-activation of these mechanisms can lead to intraglomerular hypertension and albuminuria, other associated mechanisms related to the activation of inflammasome pathways, including endothelial and tubular damage, and the hemodynamic effects of increased activity of the renin-angiotensin-aldosterone system, among others, are recognized pathways for the development of albuminuria. While the role of albuminuria in the progression of chronic kidney disease (CKD) is well known, there is increasing evidence of its negative association with cardiovascular events. For example, the presence of albuminuria is associated with an increased likelihood of developing heart failure (HF), even in patients with normal GFR, and the role of albuminuria in atherosclerosis has recently been described. Albuminuria is associated with adverse outcomes such as mortality and HF hospitalization. On the other hand, it is increasingly known that the systemic effects of congestion are mainly preceded by increased central venous pressure and transmitted retrogradely to organs such as the liver or kidney. With regard to the latter, a new entity called congestive nephropathy is emerging, in which increased renal venous pressure can lead to albuminuria. Fortunately, the presence of albuminuria is modifiable and new treatments are now available to reverse this common risk factor in the cardiorenal interaction.
Collapse
Affiliation(s)
- Gregorio Romero-González
- Nephrology Department, Germans Trias i Pujol University Hospital, 08916 Badalona, Spain; (G.R.-G.); (N.R.-C.); (C.C.); (J.P.-M.); (M.T.); (J.S.-M.); (F.G.T.); (M.S.-B.)
- REMAR-IGTP Group (Kidney-Affecting Diseases Research Group), Germans Trias i Pujol Research Institute (IGTP), 08916 Badalona, Spain
- International Renal Research Institute of Vicenza, 36100 Vicenza, Italy
| | - Néstor Rodríguez-Chitiva
- Nephrology Department, Germans Trias i Pujol University Hospital, 08916 Badalona, Spain; (G.R.-G.); (N.R.-C.); (C.C.); (J.P.-M.); (M.T.); (J.S.-M.); (F.G.T.); (M.S.-B.)
- REMAR-IGTP Group (Kidney-Affecting Diseases Research Group), Germans Trias i Pujol Research Institute (IGTP), 08916 Badalona, Spain
| | - Carles Cañameras
- Nephrology Department, Germans Trias i Pujol University Hospital, 08916 Badalona, Spain; (G.R.-G.); (N.R.-C.); (C.C.); (J.P.-M.); (M.T.); (J.S.-M.); (F.G.T.); (M.S.-B.)
| | - Javier Paúl-Martínez
- Nephrology Department, Germans Trias i Pujol University Hospital, 08916 Badalona, Spain; (G.R.-G.); (N.R.-C.); (C.C.); (J.P.-M.); (M.T.); (J.S.-M.); (F.G.T.); (M.S.-B.)
- REMAR-IGTP Group (Kidney-Affecting Diseases Research Group), Germans Trias i Pujol Research Institute (IGTP), 08916 Badalona, Spain
| | - Marina Urrutia-Jou
- Nephrology Department, University Hospital Joan XXIII, 43005 Tarragona, Spain;
| | - Maribel Troya
- Nephrology Department, Germans Trias i Pujol University Hospital, 08916 Badalona, Spain; (G.R.-G.); (N.R.-C.); (C.C.); (J.P.-M.); (M.T.); (J.S.-M.); (F.G.T.); (M.S.-B.)
- REMAR-IGTP Group (Kidney-Affecting Diseases Research Group), Germans Trias i Pujol Research Institute (IGTP), 08916 Badalona, Spain
| | - Jordi Soler-Majoral
- Nephrology Department, Germans Trias i Pujol University Hospital, 08916 Badalona, Spain; (G.R.-G.); (N.R.-C.); (C.C.); (J.P.-M.); (M.T.); (J.S.-M.); (F.G.T.); (M.S.-B.)
- REMAR-IGTP Group (Kidney-Affecting Diseases Research Group), Germans Trias i Pujol Research Institute (IGTP), 08916 Badalona, Spain
| | - Fredzzia Graterol Torres
- Nephrology Department, Germans Trias i Pujol University Hospital, 08916 Badalona, Spain; (G.R.-G.); (N.R.-C.); (C.C.); (J.P.-M.); (M.T.); (J.S.-M.); (F.G.T.); (M.S.-B.)
- REMAR-IGTP Group (Kidney-Affecting Diseases Research Group), Germans Trias i Pujol Research Institute (IGTP), 08916 Badalona, Spain
| | - Maya Sánchez-Bayá
- Nephrology Department, Germans Trias i Pujol University Hospital, 08916 Badalona, Spain; (G.R.-G.); (N.R.-C.); (C.C.); (J.P.-M.); (M.T.); (J.S.-M.); (F.G.T.); (M.S.-B.)
- REMAR-IGTP Group (Kidney-Affecting Diseases Research Group), Germans Trias i Pujol Research Institute (IGTP), 08916 Badalona, Spain
| | - Jordi Calabia
- Nephrology Department, University Hospital Josep Trueta, IdIBGi Research Institute, Universitat de Girona, 17007 Girona, Spain;
| | - Jordi Bover
- Nephrology Department, Germans Trias i Pujol University Hospital, 08916 Badalona, Spain; (G.R.-G.); (N.R.-C.); (C.C.); (J.P.-M.); (M.T.); (J.S.-M.); (F.G.T.); (M.S.-B.)
- REMAR-IGTP Group (Kidney-Affecting Diseases Research Group), Germans Trias i Pujol Research Institute (IGTP), 08916 Badalona, Spain
| |
Collapse
|
11
|
Rossiter A, La A, Koyner JL, Forni LG. New biomarkers in acute kidney injury. Crit Rev Clin Lab Sci 2024; 61:23-44. [PMID: 37668397 DOI: 10.1080/10408363.2023.2242481] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/14/2023] [Accepted: 07/26/2023] [Indexed: 09/06/2023]
Abstract
Acute kidney injury (AKI) is a commonly encountered clinical syndrome. Although it often complicates community acquired illness, it is more common in hospitalized patients, particularly those who are critically ill or who have undergone major surgery. Approximately 20% of hospitalized adult patients develop an AKI during their hospital care, and this rises to nearly 60% in the critically ill, depending on the population being considered. In general, AKI is more common in older adults, in those with preexisting chronic kidney disease and in those with known risk factors for AKI (including diabetes and hypertension). The development of AKI is associated with an increase in both mortality and morbidity, including the development of post-AKI chronic kidney disease. Currently, AKI is defined by a rise in serum creatinine from either a known or derived baseline value and/or oliguria or anuria. However, clinicians may fail to recognize the initial development of AKI because of a delay in the rise of serum creatinine or because of inaccurate urine output monitoring. This, in turn, delays any putative measures to treat AKI or to limit its degree. Consequently, efforts have focused on new biomarkers associated with AKI that may allow early recognition of this syndrome with the intent that this will translate into improved patient outcomes. Here we outline current biomarkers associated with AKI and explore their potential in aiding diagnosis, understanding the pathophysiology and directing therapy.
Collapse
Affiliation(s)
- Adam Rossiter
- Critical Care Unit, Royal Surrey Hospital, Guildford, Surry, UK
| | - Ashley La
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Jay L Koyner
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Lui G Forni
- Critical Care Unit, Royal Surrey Hospital, Guildford, Surry, UK
- School of Medicine, Department of Clinical & Experimental Medicine, Faculty of Health Sciences, University of Surrey, Surry, UK
| |
Collapse
|
12
|
Lai M, Scherzer R, Shlipak MG, Madden E, Vittinghoff E, Tse W, Parikh CR, Villalobos CPC, Monroy-Trujillo JM, Moore RD, Estrella MM. Ambulatory urine biomarkers associations with acute kidney injury and hospitalization in people with HIV. AIDS 2023; 37:2339-2348. [PMID: 37650762 PMCID: PMC10843826 DOI: 10.1097/qad.0000000000003705] [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] [Indexed: 09/01/2023]
Abstract
BACKGROUND People with HIV (PWH) generally have worse ambulatory levels of kidney injury biomarkers and excess risk of acute kidney injury (AKI) compared to persons without HIV. We evaluated whether ambulatory measures of subclinical kidney injury among PWH are associated with subsequent AKI. METHODS In the Predictors of Acute Renal Injury Study (PARIS), which enrolled 468 PWH from April 2016 to August 2019, we measured 10 urine biomarkers of kidney health (albumin, a1m, b2M, NGAL, IL18, KIM-1, EGF, UMOD, MCP-1, YKL40) at baseline and annually during follow-up. Using multivariable Cox regression models, we evaluated baseline and time-updated biomarker associations with the primary outcome of AKI (≥0.3 mg/dl or ≥1.5-times increase in serum creatinine from baseline) and secondary outcome of all-cause hospitalization. RESULTS At baseline, the mean age was 53 years old, and 45% self-identified as female. In time-updated models adjusting for sociodemographic factors, comorbidities, albuminuria, estimated glomerular filtration rate, and HIV-associated factors, higher KIM-1 [hazard ratio (HR) = 1.30 per twofold higher; 95% confidence interval (CI) 1.03-1.63] and NGAL concentrations (HR = 1.24, 95% CI 1.06-1.44) were associated with higher risk of hospitalized AKI. Additionally, in multivariable, time-updated models, higher levels of KIM-1 (HR = 1.19, 95% CI 1.00, 1.41), NGAL (HR = 1.13, 95% CI 1.01-1.26), and MCP-1 (HR = 1.20, 95% CI 1.00, 1.45) were associated with higher risk of hospitalization. CONCLUSIONS Urine biomarkers of kidney tubular injury, such as KIM-1 and NGAL, are strongly associated with AKI among PWH, and may hold potential for risk stratification of future AKI.
Collapse
Affiliation(s)
- Mason Lai
- Kidney Health Research Collaborative, Department of Medicine
- Department of Medicine, University of California San Francisco
| | | | - Michael G Shlipak
- Kidney Health Research Collaborative, Department of Medicine
- Department of Medicine, University of California San Francisco
- San Francisco VA Healthcare System
- Department of Epidemiology and Biostatistics
| | - Erin Madden
- Kidney Health Research Collaborative, Department of Medicine
- San Francisco VA Healthcare System
| | - Eric Vittinghoff
- Kidney Health Research Collaborative, Department of Medicine
- Department of Epidemiology and Biostatistics
| | - Warren Tse
- Kidney Health Research Collaborative, Department of Medicine
- San Francisco VA Healthcare System
| | - Chirag R Parikh
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | | | - Richard D Moore
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michelle M Estrella
- Kidney Health Research Collaborative, Department of Medicine
- Department of Medicine, University of California San Francisco
- San Francisco VA Healthcare System
- Department of Medicine, Division of Nephrology, University of California San Francisco, San Francisco, California
| |
Collapse
|
13
|
Lan H, Liu X, Yang D, Zhang D, Wang L, Hu L. Comparing diagnostic accuracy of biomarkers for acute kidney injury after major surgery: A PRISMA systematic review and network meta-analysis. Medicine (Baltimore) 2023; 102:e35284. [PMID: 37800811 PMCID: PMC10553025 DOI: 10.1097/md.0000000000035284] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 08/28/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND The timely identification of patients at risk of acute kidney injury (AKI), along with early prevention, real-time monitoring, and prompt intervention, plays a crucial role in enhancing patient prognosis after major surgery. METHODS We conducted a comprehensive search across multiple databases, including Web of Science, EMBASE, MEDLINE, China National Knowledge Infrastructure, and Cochrane Library. Each study's risk of bias was independently evaluated as low, moderate, or high, utilizing criteria adapted from Quality Assessment of Diagnostic Accuracy Studies 2. The analysis was performed using STATA V.17.0 and R software V.3.4.1. Diagnostic tests were ranked based on the dominance index. We performed meta-analyses to calculate odds ratios (ORs) and 95% confidence intervals (CIs) individually. We then carried out a network meta-analysis to compare the performances of these biomarkers. RESULTS Fifteen studies were included in this analysis. The meta-analysis findings revealed that among all the biomarkers assessed, serum cystatin C (s-CysC) (hierarchical summary receiver operating characteristic curve [HSROC] 82%, 95% CI 0.78-0.85) exhibited the highest HSROC value. The network meta-analysis demonstrated that urinary kidney injury molecule-1 (u-KIM-1) and s-CysC displayed relatively higher sensitivity and specificity, respectively. In subgroup analyses, u-KIM-1 in the urine output (OU) group (OR 303.75, 95% CI 3.39-1844.88), s-CysC in the non-OU group (OR 10.31, 95% CI 3.09-26.2), interleukin-18 in the noncardiac surgery group (OR 46.20, 95% CI 0.48-307.68), s-CysC in the cardiac group (OR 12.42, 95% CI 2.9-35.86), u-KIM-1 in the retrospective group (OR 243.00, 95% CI 1.73-1582.11), and s-CysC in the prospective group (OR 8.35, 95% CI 2.34-21.15) had the best diagnostic accuracy. However, it is important to note that existing publication bias may reduce the reliability of the above-mentioned results. CONCLUSION The biomarker of s-CysC has the highest HSROC value to predicting acute kidney injury after major surgery in meta-analysis and relatively higher specificity in network meta-analyses. u-KIM-1 exhibited relatively higher sensitivity, with best diagnostic accuracy in the OU and retrospective group in the subgroup analysis.
Collapse
Affiliation(s)
- Hui Lan
- Department of Clinical Laboratory, Zigong Third People’s Hospital, Zigong City, China
| | - Xia Liu
- Department of Clinical Laboratory, Zigong Third People’s Hospital, Zigong City, China
| | - Dongmei Yang
- Department of Clinical Laboratory, Zigong Third People’s Hospital, Zigong City, China
| | - De Zhang
- Big Data Research Center, University of Electronic Science and Technology, Chengdu, China
| | - Li Wang
- Department of Neurology, Zigong Third People’s Hospital, Zigong City, China
| | - Liping Hu
- Department of Neurology, Zigong Third People’s Hospital, Zigong City, China
| |
Collapse
|
14
|
Janosevic D, De Luca T, Ferreira RM, Gisch DL, Hato T, Luo J, Yang Y, Hodgin JB, Dagher PC, Eadon MT. miRNA and mRNA Signatures in Human Acute Kidney Injury Tissue. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.09.11.557054. [PMID: 37745313 PMCID: PMC10515816 DOI: 10.1101/2023.09.11.557054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Acute kidney injury (AKI) is an important contributor to the development of chronic kidney disease (CKD). There is a need to understand molecular mediators that drive either recovery or progression to CKD. In particular, the role of miRNA and its regulatory role in AKI is poorly understood. We performed miRNA and mRNA sequencing on biobanked human kidney tissues obtained in the routine clinical care of patients with the diagnoses of AKI and minimal change disease (MCD), in addition to nephrectomized (Ref) tissue from individuals without known kidney disease. Transcriptomic analysis of mRNA revealed that Ref tissues exhibited a similar injury signature to AKI, not identified in MCD samples. The transcriptomic signature of human AKI was enriched with genes in pathways involved in cell adhesion and epithelial-to-mesenchymal transition (e.g., CDH6, ITGB6, CDKN1A ). miRNA DE analysis revealed upregulation of miRNA associated with immune cell recruitment and inflammation (e.g., miR-146a, miR-155, miR-142, miR-122). These miRNA (i.e., miR-122, miR-146) are also associated with downregulation of mRNA such as DDR2 and IGFBP6 , respectively. These findings suggest integrated interactions between miRNAs and target mRNAs in AKI-related processes such as inflammation, immune cell activation and epithelial-to-mesenchymal transition. These data contribute several novel findings when describing the epigenetic regulation of AKI by miRNA, and also underscores the importance of utilizing an appropriate reference control tissue to understand canonical pathway alterations in AKI.
Collapse
|
15
|
Garg AX, Cuerden M, Cata J, Chan MTV, Devereaux PJ, Fleischmann E, Grande AM, Kabon B, Landoni G, Maziak DE, McLean S, Parikh C, Popova E, Reimer C, Trujillo Reyes JC, Roshanov P, Sessler DI, Srinathan S, Sontrop JM, Gonzalez Tallada A, Wang MK, Wells JR, Conen D. Effect of Colchicine on the Risk of Perioperative Acute Kidney Injury: Clinical Protocol of a Substudy of the Colchicine for the Prevention of Perioperative Atrial Fibrillation Randomized Clinical Trial. Can J Kidney Health Dis 2023; 10:20543581231185427. [PMID: 37457622 PMCID: PMC10338661 DOI: 10.1177/20543581231185427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/02/2023] [Indexed: 07/18/2023] Open
Abstract
Background Inflammation during and after surgery can lead to organ damage including acute kidney injury. Colchicine, an established inexpensive anti-inflammatory medication, may help to protect the organs from pro-inflammatory damage. This protocol describes a kidney substudy of the colchicine for the prevention of perioperative atrial fibrillation (COP-AF) study, which is testing the effect of colchicine versus placebo on the risk of atrial fibrillation and myocardial injury among patients undergoing thoracic surgery. Objective Our kidney substudy of COP-AF will determine whether colchicine reduces the risk of perioperative acute kidney injury compared with a placebo. We will also examine whether colchicine has a larger absolute benefit in patients with pre-existing chronic kidney disease, the most prominent risk factor for acute kidney injury. Design and Setting Randomized, superiority clinical trial conducted in 40 centers in 11 countries from 2018 to 2023. Patients Patients (~3200) aged 55 years and older having major thoracic surgery. Intervention Patients are randomized 1:1 to receive oral colchicine (0.5 mg tablet) or a matching placebo, given twice daily starting 2 to 4 hours before surgery for a total of 10 days. Patients, health care providers, data collectors, and outcome adjudicators will be blinded to the randomized treatment allocation. Methods Serum creatinine concentrations will be measured before surgery and on postoperative days 1, 2, and 3 (or until hospital discharge). The primary outcome of the substudy is perioperative acute kidney injury, defined as an increase (from the prerandomization value) in serum creatinine concentration of either ≥26.5 μmol/L (≥0.3 mg/dL) within 48 hours of surgery or ≥50% within 7 days of surgery. The primary analysis (intention-to-treat) will examine the relative risk of acute kidney injury in patients allocated to receive colchicine versus placebo. We will repeat the primary analysis using alternative definitions of acute kidney injury and examine effect modification by pre-existing chronic kidney disease, defined as a prerandomization estimated glomerular filtration rate (eGFR) <60 mL/min per 1.73 m2. Limitations The substudy will be underpowered to detect small effects on more severe forms of acute kidney injury treated with dialysis. Results Substudy results will be reported in 2024. Conclusions This substudy will estimate the effect of colchicine on the risk of perioperative acute kidney injury in older adults undergoing major thoracic surgery. Clinical trial registration number NCT03310125.
Collapse
Affiliation(s)
| | | | - Juan Cata
- MD Anderson Cancer Center, Houston, TX, USA
| | | | | | | | | | | | | | | | - Sean McLean
- Vancouver Acute Department of Anesthesiology, Vancouver General Hospital, BC, Canada
| | - Chirag Parikh
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | | | | | - Pavel Roshanov
- London Health Sciences Centre, ON, Canada
- Division of Nephrology, Department of Medicine, Western University, London, ON, Canada
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
- Population Health Research Institute, Hamilton, ON, Canada
| | | | | | | | | | | | | | - David Conen
- Population Health Research Institute, Hamilton, ON, Canada
| |
Collapse
|
16
|
La AM, Gunning S, Trevino SA, Kunczt A, Forni LG, Swamy V, Zarbock A, Groboske S, Leung EKY, Yeo KTJ, Koyner JL. Real-World Use of AKI Biomarkers: A Quality Improvement Project Using Urinary Tissue Inhibitor Metalloprotease-2 and Insulin-Like Growth Factor Binding Protein 7 ([TIMP-2]*[IGFBP7]). Am J Nephrol 2023; 54:281-290. [PMID: 37356428 DOI: 10.1159/000531641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 06/19/2023] [Indexed: 06/27/2023]
Abstract
INTRODUCTION Novel urinary biomarkers, including tissue inhibitor metalloprotease-2 and insulin-like growth factor binding protein 7 ([TIMP-2]*[IGFBP7]), have been developed to identify patients at risk for acute kidney injury (AKI). We investigated the "real-world" clinical utility of [TIMP-2]*[IGFBP7] in preventing AKI. METHODS We performed a before and after single-center quality improvement study of intensive care unit (ICU) patients at risk for severe (KDIGO stage 2 or 3) AKI. In the prospective cohort, ICU providers were allowed to order [TIMP-2]*[IGFBP7] for patients at their discretion, then offered AKI practice recommendations based on the results. Outcomes were compared to a historical cohort in which biomarker values were not reported to clinical teams. RESULTS There was no difference in 7-day progression to severe AKI between the prospective (n = 116) and historical cohorts (n = 63) when [TIMP-2]*[IGFBP7] ≥0.3 (24 [28%] versus 8 [21%], p = 0.38) despite more stage 1 AKI at time of biomarker measurement in the prospective cohort (58 [67%] versus 9 [23%], p < 0.001). In the prospective cohort, patients with higher [TIMP-2]*[IGFBP7] values were more likely to receive a nephrology consult. Early consultation (within 24 h of biomarker measurement, n = 20) had a nonsignificant trend toward net negative volume balance (-1,787 mL [6,716 mL] versus + 4,974 mL [15,540 mL]) and more diuretic use (19 [95%] versus 8 [80%]) and was associated with less severe AKI (9 [45%] versus 10 [100%], p = 0.004) and inpatient dialysis (2 [10%] versus 7 [70%], p = 0.002) compared to delayed consultation (n = 10). CONCLUSIONS Despite the prospective cohort having more preexisting stage 1 AKI, there were equal rates of progression to severe AKI in the prospective and historical cohorts. In the setting of [TIMP-2]*[IGFBP7] reporting, there were more nephrology consults in response to elevated biomarker levels. Early nephrology consultation resulted in improved volume balance and favorable outcomes compared to delayed consultation.
Collapse
Affiliation(s)
- Ashley M La
- Department of Internal Medicine, University of Chicago, Chicago, Illinois, USA
| | - Samantha Gunning
- Section of Nephrology, Department of Internal Medicine, University of Chicago, Chicago, Illinois, USA
| | - Sharon A Trevino
- Section of Nephrology, Department of Internal Medicine, University of Chicago, Chicago, Illinois, USA
| | - Alissa Kunczt
- Section of Nephrology, Department of Internal Medicine, University of Chicago, Chicago, Illinois, USA
| | - Lui G Forni
- Department of Intensive Care Medicine, Royal Surrey Hospital and Faculty of Health Sciences, University of Surrey, Guildford, UK
| | - Varsha Swamy
- Department of Internal Medicine, University of Chicago, Chicago, Illinois, USA
| | - Alexander Zarbock
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, University Hospital Munster, Munster, Germany
- Outcomes Research Consortium, Cleveland, Ohio, USA
| | - Sarah Groboske
- Section of Clinical Chemistry, Department of Pathology, University of Chicago, Chicago, Illinois, USA
| | - Edward K Y Leung
- Section of Clinical Chemistry, Department of Pathology, University of Chicago, Chicago, Illinois, USA
| | - Kiang-Teck J Yeo
- Section of Clinical Chemistry, Department of Pathology, University of Chicago, Chicago, Illinois, USA
| | - Jay L Koyner
- Section of Nephrology, Department of Internal Medicine, University of Chicago, Chicago, Illinois, USA
| |
Collapse
|
17
|
Vasquez-Rios G, Oh W, Lee S, Bhatraju P, Mansour SG, Moledina DG, Gulamali FF, Siew ED, Garg AX, Sarder P, Chinchilli VM, Kaufman JS, Hsu CY, Liu KD, Kimmel PL, Go AS, Wurfel MM, Himmelfarb J, Parikh CR, Coca SG, Nadkarni GN. Joint Modeling of Clinical and Biomarker Data in Acute Kidney Injury Defines Unique Subphenotypes with Differing Outcomes. Clin J Am Soc Nephrol 2023; 18:716-726. [PMID: 36975209 PMCID: PMC10278836 DOI: 10.2215/cjn.0000000000000156] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 03/13/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND AKI is a heterogeneous syndrome. Current subphenotyping approaches have only used limited laboratory data to understand a much more complex condition. METHODS We focused on patients with AKI from the Assessment, Serial Evaluation, and Subsequent Sequelae in AKI (ASSESS-AKI). We used hierarchical clustering with Ward linkage on biomarkers of inflammation, injury, and repair/health. We then evaluated clinical differences between subphenotypes and examined their associations with cardiorenal events and death using Cox proportional hazard models. RESULTS We included 748 patients with AKI: 543 (73%) of them had AKI stage 1, 112 (15%) had AKI stage 2, and 93 (12%) had AKI stage 3. The mean age (±SD) was 64 (13) years; 508 (68%) were men; and the median follow-up was 4.7 (Q1: 2.9, Q3: 5.7) years. Patients with AKI subphenotype 1 ( N =181) had the highest kidney injury molecule (KIM-1) and troponin T levels. Subphenotype 2 ( N =250) had the highest levels of uromodulin. AKI subphenotype 3 ( N =159) comprised patients with markedly high pro-brain natriuretic peptide and plasma tumor necrosis factor receptor-1 and -2 and low concentrations of KIM-1 and neutrophil gelatinase-associated lipocalin. Finally, patients with subphenotype 4 ( N =158) predominantly had sepsis-AKI and the highest levels of vascular/kidney inflammation (YKL-40, MCP-1) and injury (neutrophil gelatinase-associated lipocalin, KIM-1). AKI subphenotypes 3 and 4 were independently associated with a higher risk of death compared with subphenotype 2 and had adjusted hazard ratios of 2.9 (95% confidence interval, 1.8 to 4.6) and 1.6 (95% confidence interval, 1.01 to 2.6, P = 0.04), respectively. Subphenotype 3 was also independently associated with a three-fold risk of CKD and cardiovascular events. CONCLUSIONS We discovered four AKI subphenotypes with differing clinical features and biomarker profiles that are associated with longitudinal clinical outcomes.
Collapse
Affiliation(s)
- George Vasquez-Rios
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Wonsuk Oh
- Mount Sinai Clinical Intelligence Center, Icahn School of Medicine at Mount Sinai, New York, New York
- Division of Data-Driven and Digital Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Samuel Lee
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Pavan Bhatraju
- Division of Nephrology, Department of Medicine, Kidney Research Institute, University of Washington, Seattle, Washington
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington
| | - Sherry G. Mansour
- Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut
| | - Dennis G. Moledina
- Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut
| | - Faris F. Gulamali
- Mount Sinai Clinical Intelligence Center, Icahn School of Medicine at Mount Sinai, New York, New York
- Division of Data-Driven and Digital Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Edward D. Siew
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Amit X. Garg
- Division of Nephrology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Pinaki Sarder
- Department of Biomedical Engineering, SUNY Buffalo, Buffalo, New York
| | - Vernon M. Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - James S. Kaufman
- Division of Nephrology, Veterans Affairs New York Harbor Healthcare System and New York University School of Medicine, New York, New York
| | - Chi-yuan Hsu
- Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Kathleen D. Liu
- Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Paul L. Kimmel
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Alan S. Go
- Kaiser Permanente Northern California, Oakland, California
| | - Mark M. Wurfel
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington
| | - Jonathan Himmelfarb
- Division of Nephrology, Department of Medicine, Kidney Research Institute, University of Washington, Seattle, Washington
| | - Chirag R. Parikh
- Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Steven G. Coca
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Girish N. Nadkarni
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- Mount Sinai Clinical Intelligence Center, Icahn School of Medicine at Mount Sinai, New York, New York
- Division of Data-Driven and Digital Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| |
Collapse
|
18
|
Tian M, Liu X, Chen L, Hu S, Zheng Z, Wang L, Wang X, Gao H, Sun W. Urine metabolites for preoperative prediction of acute kidney injury after coronary artery bypass graft surgery. J Thorac Cardiovasc Surg 2023; 165:1165-1175.e3. [PMID: 33994002 DOI: 10.1016/j.jtcvs.2021.03.118] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 03/24/2021] [Accepted: 03/26/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Acute kidney injury is a common complication after on-pump coronary artery bypass grafting. Prediction of acute kidney injury remains a challenge. Our study aims to identify a panel of urine metabolites for preoperative warning of acute kidney injury after on-pump coronary artery bypass grafting. METHODS A total of 159 patients undergoing isolated on-pump coronary artery bypass grafting were enrolled from July 7, 2017, to May 17, 2019. Preoperative urine samples were analyzed with the approach of liquid chromatography-mass spectrometry-based urine metabolomics. The study end point was the episode of acute kidney injury within 48 hours postoperatively. The predictive performance was determined by the area under the curve and calibration curve. The results were validated using bootstrap resampling. RESULTS The acute kidney injury (n = 55) and nonacute kidney injury (n = 104) groups showed significant different metabolic profiling. A total of 28 metabolites showed significant differences between the acute kidney injury and nonacute kidney injury groups. A metabolite panel of 5 metabolites (tyrosyl-gamma-glutamate, deoxycholic acid glycine conjugate, 5-acetylamino-6-amino-3-methyluracil, arginyl-arginine, and L-methionine) was discovered to have a good predicting performance (area under the curve, 0.89; 95% confidence interval, 0.82-0.93), which is higher than the clinical factor-based model (area under the curve, 0.63; 95% confidence interval, 0.53-0.72). Internal validation by bootstrap resampling showed an adjusted area under the curve of 0.88, and the calibration curve demonstrated good agreement between prediction and observation in the probability of postoperative acute kidney injury. Decision curve analysis revealed a superior net benefit of the metabolite model over the traditional clinical factor-based model. CONCLUSIONS We present 5 urine metabolites related to acute kidney injury after coronary artery bypass grafting. This metabolite model may serve as a preoperative warning of acute kidney injury after on-pump coronary artery bypass grafting.
Collapse
Affiliation(s)
- Meice Tian
- Department of Surgery, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiaoyan Liu
- Core Facility of Instrument, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Liang Chen
- Department of Surgery, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shengshou Hu
- Department of Surgery, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhe Zheng
- Department of Surgery, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Liqing Wang
- Department of Surgery, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xianqiang Wang
- Department of Surgery, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Huawei Gao
- Department of Surgery, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
| | - Wei Sun
- Core Facility of Instrument, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China.
| |
Collapse
|
19
|
Kamianowska M, Kamianowska A, Wasilewska A. Urinary levels of kidney injury molecule-1 (KIM-1) and interleukin-18 (IL-18) in children and adolescents with hyperuricemia. Adv Med Sci 2023; 68:79-85. [PMID: 36774664 DOI: 10.1016/j.advms.2023.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 11/18/2022] [Accepted: 01/29/2023] [Indexed: 02/14/2023]
Abstract
PURPOSE Hyperuricemia may lead to silent tissue damage and increase the risk of some diseases, including kidney diseases. Increased serum uric acid concentration induces inflammatory pathways and promotes kidney damage. This study aimed to determine whether hyperuricemia influences the levels of urinary kidney injury markers in children and adolescents with hyperuricemia, assessed by the urinary concentrations of interleukin-18, a biomarker of inflammation, and kidney injury molecule-1 (KIM-1), a biomarker of kidney injury. MATERIAL AND METHODS The study included 73 children and adolescents (32 males and 41 females) aged 2-18 years. They were divided into two groups: hyperuricemia (HU) group (n = 48) and normouricemia - reference group (R) (n = 25). The concentrations of urinary interleukin-18 and KIM-1 were measured using an ELISA kit and were normalized for urinary creatinine (cr.) concentration. RESULTS The median interleukin-18/cr. Levels in the HU group were significantly higher than in the R group (median, Q1-Q3) 21.83 (11.32-35.96) and 12.68 (7.11-24.04), respectively, (p < 0.05). The KIM-1/cr. in the HU group and the R group were (median, Q1-Q3) 0.79 (0.45-1.03) and 0.81 (0.59-1.01), respectively, and the difference was not significant. KIM-1/cr. did not differ between the groups. Interleukin-18/cr. ratio correlated positively with serum uric acid concentration (r = 0.24, p < 0.05). CONCLUSIONS Interleukin-18/cr., but not KIM-1/cr. was higher in children with hyperuricemia. Hyperuricemia results in increased IL-18 in urine, in absence of other markers of kidney injury, suggesting inflammation in the kidney. Additional studies on the adults should be done, to confirm this hypothesis.
Collapse
Affiliation(s)
- Monika Kamianowska
- Department of Neonatology and Neonatal Intensive Care, Medical University of Bialystok, Bialystok, Poland.
| | - Aleksandra Kamianowska
- Department of Pediatrics and Nephrology, Medical University of Bialystok, Bialystok, Poland
| | - Anna Wasilewska
- Department of Pediatrics and Nephrology, Medical University of Bialystok, Bialystok, Poland
| |
Collapse
|
20
|
Marahrens B, Damsch L, Lehmann R, Matyukhin I, Patschan S, Patschan D. Increased Serum Sodium at Acute Kidney Injury Onset Predicts In-Hospital Death. J Clin Med Res 2023; 15:90-98. [PMID: 36895623 PMCID: PMC9990719 DOI: 10.14740/jocmr4845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/05/2023] [Indexed: 03/04/2023] Open
Abstract
Background Over the last decades, acute kidney injury (AKI) has been identified as a potentially fatal diagnosis which substantially increases in-hospital mortality in the short term and morbidity/mortality in the long term. However, reliable biomarkers for predicting AKI-associated outcomes are still missing. In this study, we assessed whether serum sodium, measured at different time points during the in-hospital treatment period, provided prognostic information in AKI. Methods This was a retrospective, observational cohort study. AKI subjects were identified via the in-hospital AKI alert system. Serum sodium and potassium levels were documented at five pre-defined time points: hospital admission, AKI onset, minimum estimated glomerular filtration rate, minimum and maximum of the respective electrolyte during the treatment period. In-hospital death, the need for kidney replacement therapy (KRT) and recovery of kidney function were defined as endpoints. Results Patients who suffered in-hospital death (n = 37, 23.1%) showed significantly higher serum sodium levels at diagnosis of AKI (survivors: 145.7 ± 2.13 vs. non-survivors: 138.8 ± 0.636 mmol/L, P = 0.003). A logistic regression model was significant for serum sodium levels in patients with in-hospital death (X2, P = 0.003; odds ratio = 1.08 (1.022 - 1.141); R2 = 0.082; d = 0.089). This suggests an increase of the relative risk for in-hospital death by 8% with every unit of serum sodium increase. Patients with a sodium above the upper normal range at AKI diagnosis were also more likely to suffer in-hospital death (P = 0.001). Conclusion In summary, we present evidence that serum sodium, measured at time of AKI diagnosis, potentially serves as a predictor for in-hospital death in patients with AKI.
Collapse
Affiliation(s)
- Benedikt Marahrens
- Innere Medizin 1, Kardiologie, Angiologie, Nephrologie, Universitatsklinikum Brandenburg, Medizinische Hochschule Brandenburg, Brandenburg, Germany.,These authors contributed equally to the study
| | - Leah Damsch
- Innere Medizin 1, Kardiologie, Angiologie, Nephrologie, Universitatsklinikum Brandenburg, Medizinische Hochschule Brandenburg, Brandenburg, Germany.,These authors contributed equally to the study
| | - Rebecca Lehmann
- Innere Medizin 1, Kardiologie, Angiologie, Nephrologie, Universitatsklinikum Brandenburg, Medizinische Hochschule Brandenburg, Brandenburg, Germany
| | - Igor Matyukhin
- Innere Medizin 1, Kardiologie, Angiologie, Nephrologie, Universitatsklinikum Brandenburg, Medizinische Hochschule Brandenburg, Brandenburg, Germany
| | - Susann Patschan
- Innere Medizin 1, Kardiologie, Angiologie, Nephrologie, Universitatsklinikum Brandenburg, Medizinische Hochschule Brandenburg, Brandenburg, Germany
| | - Daniel Patschan
- Innere Medizin 1, Kardiologie, Angiologie, Nephrologie, Universitatsklinikum Brandenburg, Medizinische Hochschule Brandenburg, Brandenburg, Germany
| |
Collapse
|
21
|
Chen H, Maron L, Segev G. Short-term intra-individual variation of urinary biomarkers in dogs with stable chronic kidney disease. J Vet Intern Med 2023; 37:184-190. [PMID: 36629796 PMCID: PMC9889610 DOI: 10.1111/jvim.16619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 12/14/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Active-ongoing kidney damage is present in animals with stable chronic kidney disease (CKD), as reflected by biomarkers in urine. Interpretation of serial messurements of biomarkers requires knowledge of its intra-individual variation. AIMS To evaluate the short-term intra-individual variation of urinary neutrophil gelatinase-associated lipocalin and kidney injury molecule-1 (uNGAL, uKIM-1, respectively) in dogs with stable CKD, and to determine whether normalization to urinary creatinine (uCr) decreases variation. ANIMALS Twenty-five dogs with naturally-occurring stable CKD. METHODS Prospective, observational study. Dogs were diagnosed with CKD based on the International Renal Interest Society guidelines. Dogs were included only if the variation in serum creatinine concentration was <25% on at least 2 measurements during the 3 months preceding inclusion, and only if serum creatinine variation was <20% during the 14-day study period. Urine samples were collected on days 0, 4, 10 and 14. uNGAL and uKIM-1 were measured using ELISA. RESULTS The median coefficients of variation (CV) of uNGAL and uNGAL/uCr were 42% (range, 7%-127%), and 44% (range, 8%-100%), respectively, and the CV 90th percentiles were 97% and 83%, respectively. The median CV of uKIM-1 and uKIM-1/uCr were 29% (range, 16%-91%), and 23% (range, 6%-76%), respectively, and the CV 90th percentiles were 56% and 52%, respectively. CONCLUSIONS AND CLINICAL IMPORTANCE Changes of >100% and >60% for uNGAL and uKIM-1, respectively, in serial measurements are higher than the normal expected variation and therefore might indicate need for further investigation for underlying causes of kidney damage.
Collapse
Affiliation(s)
- Hilla Chen
- Veterinary Teaching Hospital, Koret School of Veterinary MedicineThe Hebrew University of JerusalemRehovotIsrael
| | - Lotem Maron
- Veterinary Teaching Hospital, Koret School of Veterinary MedicineThe Hebrew University of JerusalemRehovotIsrael
| | - Gilad Segev
- Veterinary Teaching Hospital, Koret School of Veterinary MedicineThe Hebrew University of JerusalemRehovotIsrael
| |
Collapse
|
22
|
Vasquez-Rios G, Moledina DG, Jia Y, McArthur E, Mansour SG, Thiessen-Philbrook H, Shlipak MG, Koyner JL, Garg AX, Parikh CR, Coca SG. Pre-operative kidney biomarkers and risks for death, cardiovascular and chronic kidney disease events after cardiac surgery: the TRIBE-AKI study. J Cardiothorac Surg 2022; 17:338. [PMID: 36567329 PMCID: PMC9790121 DOI: 10.1186/s13019-022-02066-4] [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: 03/20/2022] [Accepted: 12/08/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Soluble tumor necrosis factor receptor (sTNFR)1, sTNFR2, and plasma kidney injury molecule-1 (KIM-1) are associated with kidney events in patients with and without diabetes. However, their associations with clinical outcomes when obtained pre-operatively have not been explored. METHODS The TRIBE-AKI cohort study is a prospective, multicenter, cohort study of high-risk adults undergoing cardiac surgery. We assessed the associations between pre-operative concentrations of plasma sTNFR1, sTNFR2, and KIM-1 and post-operative long-term outcomes including mortality, cardiovascular events, and chronic kidney disease (CKD) incidence or progression after discharge. RESULTS Among 1378 participants included in the analysis with a median follow-up period of 6.7 (IQR 4.0-7.9) years, 434 (31%) patients died, 256 (19%) experienced cardiovascular events and out of 837 with available long-term kidney function data, 30% developed CKD. After adjustment for clinical covariates, each log increase in biomarker concentration was independently associated with mortality with 95% CI adjusted hazard ratios (aHRs) of 3.0 (2.3-4.0), 2.3 (1.8-2.9), and 2.0 (1.6-2.4) for sTNFR1, sTNFR2, and KIM-1, respectively. For cardiovascular events, the 95% CI aHRs were 2.1 (1.5-3.1), 1.9 (1.4-2.6) and 1.6 (1.2-2.1) for sTNFR1, sTNFR2 and KIM-1, respectively. For CKD events, the aHRs were 2.2 (1.5-3.1) for sTNFR1, 1.9 (1.3-2.7) for sTNFR2, and 1.7 (1.3-2.3) for KIM-1. Despite the associations, each of the biomarkers alone or in combination failed to result in robust discrimination on an absolute basis or compared to a clinical model. CONCLUSION sTNFR1, sTNFR2, and KIM-1 were independently associated with longitudinal outcomes after discharge from a cardiac surgery hospitalization including death, cardiovascular, and CKD events when obtained pre-operatively in high-risk individuals. Pre-operative plasma biomarkers could serve to assist during the evaluation of patients in whom cardiac surgery is planned.
Collapse
Affiliation(s)
- George Vasquez-Rios
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1243, New York, NY, 10029, USA
| | - Dennis G Moledina
- Section of Nephrology and Clinical and Translational Research Accelerator, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Yaqi Jia
- Division of Nephrology, School of Medicine, Johns Hopkins University, 1830 E. Monument St., Suite 416, Baltimore, MD, 21287, USA
| | | | - Sherry G Mansour
- Section of Nephrology and Clinical and Translational Research Accelerator, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Heather Thiessen-Philbrook
- Division of Nephrology, School of Medicine, Johns Hopkins University, 1830 E. Monument St., Suite 416, Baltimore, MD, 21287, USA
| | - Michael G Shlipak
- Kidney Health Research Collaborative, University of California San Francisco, San Francisco, CA, USA.,Department of Medicine, San Francisco VA Medical Center and University of California, San Francisco, USA
| | - Jay L Koyner
- Section of Nephrology, Department of Medicine, Pritzker School of Medicine University of Chicago, Chicago, USA
| | - Amit X Garg
- ICES, Toronto, ON, Canada.,Division of Nephrology, Department of Medicine, Western University, London, ON, Canada
| | - Chirag R Parikh
- Division of Nephrology, School of Medicine, Johns Hopkins University, 1830 E. Monument St., Suite 416, Baltimore, MD, 21287, USA.
| | - Steven G Coca
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1243, New York, NY, 10029, USA.
| | | |
Collapse
|
23
|
The Utility of Novel Kidney Injury Biomarkers in Early Detection of CSA-AKI. Int J Mol Sci 2022; 23:ijms232415864. [PMID: 36555506 PMCID: PMC9785959 DOI: 10.3390/ijms232415864] [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: 11/23/2022] [Revised: 12/12/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Cardiac surgery-associated acute kidney injury (CSA-AKI) is one of the most common complications of cardiac surgery procedures. In this study, the authors attempt to provide new data regarding the application of novel kidney injury biomarkers in the early diagnostics of CSA-AKI. 128 adult patients undergoing elective cardiac surgery procedures with the use of cardiopulmonary by-pass (CPB) were enrolled in this study. Novel kidney injury biomarkers were marked in the plasma and urine 6 h after weaning from the CPB. A significant difference in the postoperative biomarkers' concentration between the AKI and no-AKI group was found, regarding plasma IL-8, plasma TNF-α and urine NGAL, normalized for creatinine excretion (NGAL/Cr). These were also independent predictors of CSA-AKI. An independent risk factor for CSA-AKI proved to be preoperative CKD. Plasma IL-8 and TNF-α, as well as urine NGAL/Cr, are independent early indicators of CSA-AKI and pose a promising alternative for creatinine measurements. The cut-off points for these biomarkers proposed in this investigation should be confronted with more data and revised to achieve a suitable diagnostic value.
Collapse
|
24
|
Liu S, Li M, Yang Y, Chen Y, Wang W, Zheng X. A novel risk model based on white blood cell-related biomarkers for acute kidney injury prediction in patients with ischemic stroke admitted to the intensive care unit. Front Med (Lausanne) 2022; 9:1043396. [PMID: 36579155 PMCID: PMC9790932 DOI: 10.3389/fmed.2022.1043396] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/17/2022] [Indexed: 12/14/2022] Open
Abstract
Background Conventional systemic inflammatory biomarkers could predict prognosis in patients with ischemic stroke (IS) admitted to the intensive care unit (ICU). Acute kidney injury (AKI) is common in patients with IS admitted to ICU, but few studies have used systemic inflammatory biomarkers to predict AKI in critically ill patients with IS. This study aimed to establish a risk model based on white blood cell (WBC)-related biomarkers to predict AKI in critically ill patients with IS. Methods Data were extracted from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) for a training cohort, and data were extracted from the Medical Information Mart for eICU Collaborative Research Database (eICU-CRD) for a validation cohort. Logistic regression analysis was used to determine the significant predictors of WBC-related biomarkers on AKI prediction, and a risk model was established based on those significant indicators in multivariate logistic regression. The receiver operating characteristics (ROC) curve was utilized to obtain the best cut-off value of the risk model. The Kaplan-Meier curve was used to evaluate the prognosis-predictive ability of the risk model. Results The overall incidence of AKI was 28.4% in the training cohort and 33.2% in the validation cohort. WBC to lymphocyte ratio (WLR), WBC to basophils ratio (WBR), WBC to hemoglobin ratio (WHR), and neutrophil to lymphocyte ratio (NLR) could independently predict AKI, and a novel risk model was established based on WLR, WBR, WHR, and NLR. This risk model depicted good prediction performance both in AKI and other clinical outcomes including hemorrhage, persistent AKI, AKI progression, ICU mortality, and in-hospital mortality both in the training set and in the validation set. Conclusion A risk model based on WBC-related indicators exhibited good AKI prediction performance in critically ill patients with IS which could provide a risk stratification tool for clinicians in the ICU.
Collapse
Affiliation(s)
- Shengyuan Liu
- Department of Neurosurgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Min Li
- Department of Physiology, Zunyi Medical and Pharmaceutical College, Zunyi, Guizhou, China
| | - Yuxing Yang
- Department of Urology, The People’s Hospital of Yubei District of Chongqing City, Chongqing, China
| | - Yiguo Chen
- Department of Orthopedics, The People’s Hospital of Yubei District of Chongqing City, Chongqing, China
| | - Wei Wang
- Department of Orthopedics, The People’s Hospital of Yubei District of Chongqing City, Chongqing, China,*Correspondence: Wei Wang,
| | - Xiaoyu Zheng
- School of Clinical Medicine, Chongqing Medical and Pharmaceutical College, Chongqing, China,Xiaoyu Zheng,
| |
Collapse
|
25
|
Zakaria M, Hassan T, Refaat A, Fathy M, Hashem MI, Khalifa N, Ali AA, Elhewala A, Ramadan A, Nafea A. Role of serum cystatin C in the prediction of acute kidney injury following pediatric cardiac surgeries: A single center experience. Medicine (Baltimore) 2022; 101:e31938. [PMID: 36626503 PMCID: PMC9750614 DOI: 10.1097/md.0000000000031938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Intense contemporary research is directed towards validating novel biomarkers to predict acute kidney injury (AKI) in children undergoing cardiothoracic surgeries. We aimed to evaluate the role of cystatin C in early prediction of AKI following cardiac surgery in children with congenital heart disease. Prospective observational cohort study was conducted on 40 children with congenital heart disease undergoing cardiac surgery. 40 healthy children with matched age and sex were enrolled as a control group. Children were subjected to physical examination, routine blood tests, echocardiography, and measurement of plasma cystatin C level on different occasions. The median age of the patients was 3.65 years, a range from 1 to 5 years with no significant difference regarding the age and sex of cases and control groups. The mean serum cystatin C level in patients was 0.75 ± 0.15, 1.35 ± 0.34 and 1.21 ± 0.38 mg/dL (preoperative, at 6 h and at 24 h postoperative, respectively) with statistically significant difference P < .05. 30% of the patients developed postoperative AKI with significantly higher serum cystatin C at 6 hours postoperative >1.33 mg/dL compared to preoperative level p P < .05. Serum cystatin C level was positively correlated with cardiac bypass time, ischemic time and length of hospital stay at 6 hours postoperative. Serum cystatin C is a sensitive marker for early detection of AKI following cardiac surgery in children with congenital heart disease and it was positively correlated with cardiac bypass time, ischemic time and length of hospital stay.
Collapse
Affiliation(s)
- Marwa Zakaria
- Pediatrics Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
- *Correspondence: Marwa Zakaria, Pediatric Department, Faculty of Medicine, Zagazig University, Zagazig 44519, Egypt (e-mail: )
| | - Tamer Hassan
- Pediatrics Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ali Refaat
- Cardiothoracic Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Manar Fathy
- Pediatrics Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mustafa I.A. Hashem
- Pediatrics Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Naglaa Khalifa
- Clinical Pathology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed A. Ali
- Pediatrics Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed Elhewala
- Pediatrics Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed Ramadan
- Pediatrics Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Alaa Nafea
- Pediatrics Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| |
Collapse
|
26
|
Cheng L, Wang L, Chen B, Wang C, Wang M, Li J, Gao X, Zhang Z, Han L. A multiple-metabolites model to predict preliminary renal injury induced by iodixanol based on UHPLC/Q-Orbitrap-MS and 1H-NMR. Metabolomics 2022; 18:85. [PMID: 36307737 DOI: 10.1007/s11306-022-01942-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 10/11/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND & AIMS There are some problems, such as unclear pathological mechanism, delayed diagnosis, and inaccurate therapeutic target of Contrast-induced acute kidney injury (CI-AKI). It is significantly important to find biomarkers and therapeutic targets that can indicate renal injury in the early stage of CI-AKI. This study aims to establish a multiple-metabolites model to predict preliminary renal injury induced by iodixanol and explore its pathogenesis. METHODS Both UHPLC/Q-Orbitrap-MS and 1H-NMR methods were applied for urine metabolomics studies on two independent cohorts who suffered from a preliminary renal injury caused by iodixanol, and the multivariate statistical analysis and random forest (RF) algorithm were used to process the related date. RESULTS In the discovery cohort (n = 169), 6 metabolic markers (leucine, indole, 5-hydroxy-L-tryptophan, N-acetylvaline, hydroxyhexanoycarnine, and kynurenic acid) were obtained by the cross-validation between the RF and liquid chromatography-mass spectrometry (LC-MS). Secondly, the 6 differential metabolites were confirmed by comparison of standard substance and structural identification of 1H-NMR. Subsequently, the multiple-metabolites model composed of the 6 biomarkers was validated in a validation cohort (n = 165). CONCLUSIONS The concentrations of leucine, indole, N-acetylvaline, 5-hydroxy-L-tryptophan, hydroxyhexanoycarnitine and kynurenic acid in urine were proven to be positively correlated with the degree of renal injury induced by iodixanol. The multiple-metabolites model based on these 6 biomarkers has a good predictive ability to predict early renal injury caused by iodixanol, provides treatment direction for injury intervention and a reference for reducing the incidence of clinical CI-AKI further.
Collapse
Affiliation(s)
- Liying Cheng
- State Key Laboratory of Component-Based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, People's Republic of China
| | - Liming Wang
- State Key Laboratory of Component-Based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, People's Republic of China
| | - Biying Chen
- State Key Laboratory of Component-Based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, People's Republic of China
| | - Chenxi Wang
- State Key Laboratory of Component-Based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, People's Republic of China
| | - Mengxi Wang
- First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, 210000, People's Republic of China
| | - Jie Li
- Tianjin Key Laboratory of Clinical Multi-Omics, Airport Economy Zone, Tianjin, 300308, People's Republic of China
| | - Xiumei Gao
- State Key Laboratory of Component-Based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, People's Republic of China.
| | - Zhu Zhang
- Department of Nephrology, Fuwai Huazhong Cardiovascular Hospital, Zhengzhou, 451464, People's Republic of China.
| | - Lifeng Han
- State Key Laboratory of Component-Based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, People's Republic of China.
| |
Collapse
|
27
|
Seyahi NS, Ozcan SG. Application of New Acute Kidney Injury Biomarkers. Biomark Med 2022. [DOI: 10.2174/9789815040463122010021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Kidney-related biomarkers can provide structural and functional information
about different parts of the nephron. These biomarkers can be used to evaluate
glomerular, tubular, or interstitial injury, inflammation, or repair, and glomerular or
tubular function. Furthermore, biomarkers can improve the acute kidney injury
diagnosis in various clinical conditions, including acute interstitial nephritis, acute
tubular injury, hepatorenal and cardiorenal syndrome, ischemic and nephrotoxic acute
kidney injury, and drug-induced acute kidney injury. Biomarkers might be used as an
additional precision medicine tool in managing patients with acute kidney injury; they
can help with clinical decision-making and impact patient outcomes. In this chapter, we
reviewed the utility of biomarkers used in acute kidney injury.
Collapse
Affiliation(s)
- Nurhan Seyahi Seyahi
- Department of Nephrology, Cerrahpasa Medical Faculty, Istanbul University - Cerrahpasa,
Istanbul, Turkey
| | - Seyda Gul Ozcan
- Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University -
Cerrahpasa, Istanbul, Turkey
| |
Collapse
|
28
|
Tekin S, Beytur A, Cakir M, Taslıdere A, Erden Y, Tekin C, Sandal S. Protective effect of saxagliptin against renal ischaemia reperfusion injury in rats. Arch Physiol Biochem 2022; 128:608-618. [PMID: 31979992 DOI: 10.1080/13813455.2020.1715442] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Saxagliptin is an effective and selective dipeptidyl peptidase-4 (DPP-4) inhibitor. This study was designed to determine possible protective effects of saxagliptin against damage caused by renal ischaemia/reperfusion (I/R) in rats. In this study, 40 rats were divided into 4 groups (n = 10 for each). Group 1 (Control), Group 2 (I/R) in both kidneys ischaemia of 45 min was performed, and then reperfusion was applied for 24 h. Saxagliptin (Group 3: 2 mg/kg and Group 4: 10 mg/kg) was administered by oral gavage to the animals in treatment groups, before the I/R. Saxagliptin decreased the markers (BUN, Cre, NGAL, KIM-1 and IL-18) of acute renal damage in blood and kidney tissue. Saxagliptin provided increase in antioxidant enzyme levels and decrease in MDA and apoptosis. Histological results showed that the administration of saxagliptin exhibited a protective effect against renal damage caused by I/R. These results indicates that saxagliptin provide protection against kidney injury caused by I/R.
Collapse
Affiliation(s)
- Suat Tekin
- Faculty of Medicine, Department of Physiology, Inonu University, Malatya, Turkey
| | - Asiye Beytur
- Faculty of Medicine, Department of Physiology, Inonu University, Malatya, Turkey
| | - Murat Cakir
- Faculty of Medicine, Department of Physiology, Yozgat Bozok University, Yozgat, Turkey
| | - Aslı Taslıdere
- Faculty of Medicine, Department of Histology and Embryology, Inonu University, Malatya, Turkey
| | - Yavuz Erden
- Faculty of Science, Department of Molecular Biology and Genetics, Bartin University, Bartin, Turkey
| | - Cigdem Tekin
- Health Services Vocational School, Inonu University, Malatya, Turkey
| | - Suleyman Sandal
- Faculty of Medicine, Department of Physiology, Inonu University, Malatya, Turkey
| |
Collapse
|
29
|
Li D, Zhao L, Qian J, Liu H, You J, Cheng Z, Yu F. SERS based Y-shaped aptasensor for early diagnosis of acute kidney injury. RSC Adv 2022; 12:15910-15917. [PMID: 35733690 PMCID: PMC9135001 DOI: 10.1039/d2ra02813a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 05/16/2022] [Indexed: 12/03/2022] Open
Abstract
Considering the pivotal role of biomarkers in plasma, the development of biomarker specific sensing platforms is of great significance to achieve accurate diagnosis and monitor the occurrence and progress in acute kidney injury (AKI). In this paper, we develop a promising surface-enhanced Raman scattering-based aptasensor for duplex detection of two protein biomarkers in AKI. Exploiting the base-pairing specificity of nucleic acids to form a Y-shaped self-assembled aptasensor, the MGITC labelled gold nanoparticles will be attached to the surface of magnetic beads. In the presence of specific AKI-related biomarkers, the gold nanoparticles will detach from magnetic beads into the supernatant, thus leading to a SERS signal increase, which can be used for the highly sensitive analysis of target biomarkers. In addition, the limit of detection calculated for each biomarker indicates that the SERS-based aptasensor can well meet the detection requirements in clinical applications. Finally, the generality of this sensor in the early diagnosis of AKI is confirmed by using a rat model and spiked plasma samples. This sensing platform provides a facile and general route for sensitive SERS detection of AKI-related biomarkers, which offers great promising utility for in vitro and accurate practical bioassay in AKI early diagnosis. We develop a promising SERS-based aptasensor for duplex detection of protein biomarkers in AKI. The development of biomarker specific sensors is of great significance to achieving accurate diagnosis and monitoring the occurrence and progress of AKI.![]()
Collapse
Affiliation(s)
- Dan Li
- Key Laboratory of Life-Organic Analysis of Shandong Province, School of Chemistry and Chemical Engineering, Qufu Normal University Qufu 273165 PR China .,Laboratory of Neurology, The First Affiliated Hospital of Hainan Medical University, Hainan Medical University Haikou 571199 China
| | - Linlu Zhao
- Laboratory of Neurology, The First Affiliated Hospital of Hainan Medical University, Hainan Medical University Haikou 571199 China .,Key Laboratory of Hainan Trauma and Disaster Rescue, Key Laboratory of Emergency and Trauma, Ministry of Education, College of Emergency and Trauma, Hainan Medical University Haikou 571199 China
| | - Jin Qian
- Laboratory of Neurology, The First Affiliated Hospital of Hainan Medical University, Hainan Medical University Haikou 571199 China .,Key Laboratory of Hainan Trauma and Disaster Rescue, Key Laboratory of Emergency and Trauma, Ministry of Education, College of Emergency and Trauma, Hainan Medical University Haikou 571199 China
| | - Heng Liu
- Laboratory of Neurology, The First Affiliated Hospital of Hainan Medical University, Hainan Medical University Haikou 571199 China .,Key Laboratory of Hainan Trauma and Disaster Rescue, Key Laboratory of Emergency and Trauma, Ministry of Education, College of Emergency and Trauma, Hainan Medical University Haikou 571199 China
| | - Jinmao You
- Key Laboratory of Life-Organic Analysis of Shandong Province, School of Chemistry and Chemical Engineering, Qufu Normal University Qufu 273165 PR China
| | - Ziyi Cheng
- Laboratory of Neurology, The First Affiliated Hospital of Hainan Medical University, Hainan Medical University Haikou 571199 China .,Key Laboratory of Hainan Trauma and Disaster Rescue, Key Laboratory of Emergency and Trauma, Ministry of Education, College of Emergency and Trauma, Hainan Medical University Haikou 571199 China
| | - Fabiao Yu
- Laboratory of Neurology, The First Affiliated Hospital of Hainan Medical University, Hainan Medical University Haikou 571199 China .,Key Laboratory of Hainan Trauma and Disaster Rescue, Key Laboratory of Emergency and Trauma, Ministry of Education, College of Emergency and Trauma, Hainan Medical University Haikou 571199 China
| |
Collapse
|
30
|
Wang X, Guo N, Chen Y, Dai H. A new model to predict acute kidney injury after cardiac surgery in patients with renal insufficiency. Ren Fail 2022; 44:767-776. [PMID: 35505569 PMCID: PMC9090423 DOI: 10.1080/0886022x.2022.2071297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Objective To establish a simple model for predicting postoperative acute kidney injury (AKI) requiring renal replacement therapy (RRT) in patients with renal insufficiency (CKD stages 3–4) who underwent cardiac surgery. Methods A total of 330 patients were enrolled. Among them, 226 were randomly selected for the development group and the remaining 104 for the validation group. The primary outcome was AKI requiring RRT. A nomogram was constructed based on the multivariate analysis with variables selected by the application of the least absolute shrinkage and selection operator. Meanwhile, the discrimination, calibration, and clinical power of the new model were assessed and compared with those of the Cleveland Clinic score and Simplified Renal Index (SRI) score in the validation group. Results: The rate of RRT in the development group was 10.6% (n = 24), while the rate in the validation group was 14.4% (n = 15). The new model included four variables such as postoperative creatinine, aortic cross‐clamping time, emergency, and preoperative cystatin C, with a C-index of 0.851 (95% CI, 0.779–0.924). In the validation group, the areas under the receiver operating characteristic curves for the new model, SRI score, and Cleveland Clinic score were 0.813, 0.791, and 0.786, respectively. Furthermore, the new model demonstrated greater clinical net benefits compared with the Cleveland Clinic score or SRI score. Conclusions We developed and validated a powerful predictive model for predicting severe AKI after cardiac surgery in patients with renal insufficiency, which would be helpful to assess the risk for severe AKI requiring RRT.
Collapse
Affiliation(s)
- Xijian Wang
- Department of Nephrology, Affiliated Hospital of Nantong University, Nantong Jiangsu, China
| | - Naifeng Guo
- Department of Nephrology, Affiliated Hospital of Nantong University, Nantong Jiangsu, China
| | - Ying Chen
- Department of Epidemiology and Medical Statistics, Nantong University School of Public Health, Nantong Jiangsu, China
| | - Houyong Dai
- Department of Nephrology, Affiliated Hospital of Nantong University, Nantong Jiangsu, China
| |
Collapse
|
31
|
La A, Koyner JL. Urine Sediment Exam Provides More Diagnostic Information in AKI than Novel Urinary Biomarkers: CON. KIDNEY360 2022; 3:600-603. [PMID: 35721617 PMCID: PMC9136909 DOI: 10.34067/kid.0004582021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 07/21/2021] [Indexed: 06/15/2023]
Affiliation(s)
- Ashley La
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Jay L. Koyner
- Section of Nephrology, Department of Medicine, University of Chicago, Chicago, Illinois
| |
Collapse
|
32
|
Skalec T, Adamik B, Kobylinska K, Gozdzik W. Soluble Urokinase-Type Plasminogen Activator Receptor Levels as a Predictor of Kidney Replacement Therapy in Septic Patients with Acute Kidney Injury: An Observational Study. J Clin Med 2022; 11:1717. [PMID: 35330042 PMCID: PMC8954771 DOI: 10.3390/jcm11061717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/10/2022] [Accepted: 03/16/2022] [Indexed: 02/01/2023] Open
Abstract
The soluble urokinase-type plasminogen activator receptor (suPAR) is involved in the pathogenesis of acute kidney injury (AKI). Our goal was to establish the optimal suPAR cut-off point for predicting the need for kidney replacement therapy (KRT) use in sepsis patients and to analyze survival rates based on the suPAR level, AKI diagnosis, and the requirement for KRT. In total, 51 septic patients were included (82% septic shock; 96% mechanically ventilated, 35% KRT). Patients were stratified according to the AKI diagnosis and the need for KRT into three groups: AKI(+)/KRT(+), AKI(+)/KRT(−), and AKI(−)/KRT(−). A control group (N = 20) without sepsis and kidney failure was included. Sepsis patients had higher levels of the suPAR than control (13.01 vs. 4.05 ng/mL, p < 0.001). On ICU admission, the suPAR level was significantly higher in the AKI(+)/KRT(+) group than in the AKI(+)/KRT(−) and AKI(−)/KRT(−) groups (18.5 vs. 10.6 and 9.5 ng/mL, respectively; p = 0.001). The optimal suPAR cut-off point for predicting the need for KRT was established at 10.422 ng/mL (area under the curve 0.801, sensitivity 0.889, specificity 0.636). Moreover, patients AKI(+)/KRT(+) had the lowest probability of survival compared to patients AKI(+)/KRT(−) and AKI(−)/KRT(−) (p = 0.0003). The results indicate that the suPAR measurements may constitute an important element in the diagnosis of a patient with sepsis.
Collapse
Affiliation(s)
- Tomasz Skalec
- Clinical Department of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, Borowska St. 213, 50-556 Wroclaw, Poland; (T.S.); (W.G.)
| | - Barbara Adamik
- Clinical Department of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, Borowska St. 213, 50-556 Wroclaw, Poland; (T.S.); (W.G.)
| | - Katarzyna Kobylinska
- Faculty of Mathematics, Informatics and Mechanics, University of Warsaw, Banacha 2, 02-097 Warsaw, Poland;
| | - Waldemar Gozdzik
- Clinical Department of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, Borowska St. 213, 50-556 Wroclaw, Poland; (T.S.); (W.G.)
| |
Collapse
|
33
|
Garg AX, Cuerden M, Aguado H, Amir M, Belley-Cote EP, Bhatt K, Biccard BM, Borges FK, Chan M, Conen D, Duceppe E, Efremov S, Eikelboom J, Fleischmann E, Giovanni L, Gross P, Jayaram R, Kirov M, Kleinlugtenbelt Y, Kurz A, Lamy A, Leslie K, Likhvantsev V, Lomivorotov V, Marcucci M, Martínez-Zapata MJ, McGillion M, McIntyre W, Meyhoff C, Ofori S, Painter T, Paniagua P, Parikh C, Parlow J, Patel A, Polanczyk C, Richards T, Roshanov P, Schmartz D, Sessler D, Short T, Sontrop JM, Spence J, Srinathan S, Stillo D, Szczeklik W, Tandon V, Torres D, Van Helder T, Vincent J, Wang CY, Wang M, Whitlock R, Wittmann M, Xavier D, Devereaux PJ. Effect of a Perioperative Hypotension-Avoidance Strategy Versus a Hypertension-Avoidance Strategy on the Risk of Acute Kidney Injury: A Clinical Research Protocol for a Substudy of the POISE-3 Randomized Clinical Trial. Can J Kidney Health Dis 2022; 9:20543581211069225. [PMID: 35024154 PMCID: PMC8744204 DOI: 10.1177/20543581211069225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/30/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Most patients who take antihypertensive medications continue taking them on
the morning of surgery and during the perioperative period. However, growing
evidence suggests this practice may contribute to perioperative hypotension
and a higher risk of complications. This protocol describes an acute kidney
injury substudy of the Perioperative Ischemic Evaluation-3 (POISE-3) trial,
which is testing the effect of a perioperative hypotension-avoidance
strategy versus a hypertension-avoidance strategy in patients undergoing
noncardiac surgery. Objective: To conduct a substudy of POISE-3 to determine whether a perioperative
hypotension-avoidance strategy reduces the risk of acute kidney injury
compared with a hypertension-avoidance strategy. Design: Randomized clinical trial with 1:1 randomization to the intervention (a
perioperative hypotension-avoidance strategy) or control (a
hypertension-avoidance strategy). Intervention: If the presurgery systolic blood pressure (SBP) is <130 mmHg, all
antihypertensive medications are withheld on the morning of surgery. If the
SBP is ≥130 mmHg, some medications (but not angiotensin receptor blockers
[ACEIs], angiotensin receptor blockers [ARBs], or renin inhibitors) may be
continued in a stepwise manner. During surgery, the patients’ mean arterial
pressure (MAP) is maintained at ≥80 mmHg. During the first 48 hours after
surgery, some antihypertensive medications (but not ACEIs, ARBs, or renin
inhibitors) may be restarted in a stepwise manner if the SBP is ≥130
mmHg. Control: Patients receive their usual antihypertensive medications before and after
surgery. The patients’ MAP is maintained at ≥60 mmHg from anesthetic
induction until the end of surgery. Setting: Recruitment from 108 centers in 22 countries from 2018 to 2021. Patients: Patients (~6800) aged ≥45 years having noncardiac surgery who have or are at
risk of atherosclerotic disease and who routinely take antihypertensive
medications. Measurements: The primary outcome of the substudy is postoperative acute kidney injury,
defined as an increase in serum creatinine concentration of either ≥26.5
μmol/L (≥0.3 mg/dL) within 48 hours of randomization or ≥50% within 7 days
of randomization. Methods: The primary analysis (intention-to-treat) will examine the relative risk and
95% confidence interval of acute kidney injury in the intervention versus
control group. We will repeat the primary analysis using alternative
definitions of acute kidney injury and examine effect modification by
preexisting chronic kidney disease, defined as a prerandomization estimated
glomerular filtration rate <60 mL/min/1.73 m2. Results: Substudy results will be analyzed in 2022. Limitations: It is not possible to mask patients or providers to the intervention;
however, objective measures will be used to assess acute kidney injury. Conclusions: This substudy will provide generalizable estimates of the effect of a
perioperative hypotension-avoidance strategy on the risk of acute kidney
injury.
Collapse
Affiliation(s)
| | | | | | - Mohammed Amir
- Shifa International Hospital (STMU), Islamabad, Pakistan
| | | | - Keyur Bhatt
- SIDS Hospital & Research Centre, Guntur, India
| | | | | | - Matthew Chan
- The Chinese University of Hong Kong, Shatin, Hong Kong
| | - David Conen
- Population Health Research Institute, Hamilton, ON, Canada
| | | | | | | | | | | | | | | | - Mikhail Kirov
- Northern State Medical University of the Ministry of Healthcare of the Russian Federation, Arkhangelsk, Russia
| | | | | | - Andre Lamy
- Population Health Research Institute, Hamilton, ON, Canada
| | | | | | | | | | | | | | | | | | - Sandra Ofori
- Population Health Research Institute, Hamilton, ON, Canada
| | | | | | | | | | | | | | - Toby Richards
- The University of Western Australia, Perth, Australia
| | | | | | | | - Tim Short
- Auckland District Health Board, New Zealand
| | | | | | | | - David Stillo
- Population Health Research Institute, Hamilton, ON, Canada
| | | | | | | | | | | | - C Y Wang
- University of Malaya, Kuala Lumpur, Malaysia
| | | | | | | | - Denis Xavier
- St. John's National Academy of Health Sciences, Bangalore, India
| | | |
Collapse
|
34
|
Perioperative albuminuria and clinical model to predict acute kidney injury in paediatric cardiac surgery. Pediatr Nephrol 2022; 37:881-890. [PMID: 34545446 PMCID: PMC8451727 DOI: 10.1007/s00467-021-05219-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/03/2021] [Accepted: 07/05/2021] [Indexed: 11/02/2022]
Abstract
BACKGROUND AKI is an important complication post cardiac surgery in children. An early diagnosis can help in mitigating complications and allow for prognostication. Urinary albumin:creatinine ratio (ACR) as a biomarker can provide a cheaper and more accessible AKI risk assessment and prediction. There is a paucity of paediatric literature regarding its utility. METHODS This was a prospective observational study, enrolling all children aged 1 month to 18 years, who underwent cardiac surgery, with use of cardiopulmonary bypass. Cohort was divided into groups < 2 years and ≥ 2 years for analyses to account for differences in physiological albumin excretion with age. RESULTS Of 143 children enrolled in the study, 36 developed AKI. In both age groups, the post-operative ACR was higher than pre-operative ACR among patients with and without AKI. In the group aged ≥ 2 years, the highest first post-operative ACR tertile (> 75.8 mg/g) predicted post-operative AKI after adjusting for clinical variables (adjusted RR, 11.71; 1.85-16.59). In the group aged < 2 years, the highest first post-operative ACR tertile (> 141.3 mg/g) predicted post-operative AKI in unadjusted analysis but not after adjusting for clinical variables (RR, 2.78; 0.70-6.65). For AKI risk prediction, AUC (95% CI) was highest after combining clinical model and pre-operative ACR for groups aged < 2 years [0.805 (0.713-0.896)] and ≥ 2 years [0.872 (0.772-0.973)]. CONCLUSIONS This study provides evidence for use of albuminuria as a feasible biomarker in AKI prediction in children post cardiac surgery, especially when added to a clinical model. A higher resolution version of the Graphical abstract is available as Supplementary information.
Collapse
|
35
|
Preservation of Renal Function. Perioper Med (Lond) 2022. [DOI: 10.1016/b978-0-323-56724-4.00017-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
36
|
Soluble IL-33 receptor predicts survival in acute kidney injury. J Circ Biomark 2022; 11:28-35. [PMID: 35707675 PMCID: PMC9185730 DOI: 10.33393/jcb.2022.2386] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/16/2022] [Indexed: 12/29/2022] Open
Abstract
Introduction: The prediction of acute kidney injury (AKI)-related outcomes remains challenging. Herein we prospectively quantified soluble ST2 (sST2), the circulating isoform of the IL-33 receptor, in hospitalized patients with AKI.
Methods: In-hospital subjects with AKI of various etiology were identified through the in-hospital AKI alert system of the Brandenburg University hospital. sST2 was measured within a maximum of 48 hours from the time of diagnosis of AKI. The following endpoints were defined: in-hospital death, dialysis, recovery of kidney function until demission.
Results: In total, 151 individuals were included in the study. The in-hospital mortality was 16.6%, dialysis therapy became mandatory in 39.7%, no recovery of kidney function occurred in 27.8%. sST2 was significantly higher in nonsurvivors (p = 0.024) but did not differ in the two other endpoints. The level of sST2 increased significantly with the severity of AKI. Further differences were detected in subjects with heart insufficiency (lower sST2), and in patients that required ICU treatment, or ventilatory therapy, or vasopressors (all higher).
Conclusions: The current study suggests sST2 as biomarker of “acute distress”: it predicts post-AKI survival and substantially increases in subjects with a higher degree of cumulative morbidity under acute circumstances (e.g., ICU therapy, vasopressor administration).
Collapse
|
37
|
Huckaby LV, Seese LM, Hess N, Aranda-Michel E, Sultan I, Gleason TG, Chu D, Wang Y, Thoma F, Kilic A. Fate of the Kidneys in Patients with Post-Operative Renal Failure After Cardiac Surgery. J Surg Res 2021; 272:166-174. [PMID: 34979472 DOI: 10.1016/j.jss.2021.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 07/20/2021] [Accepted: 08/27/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND This study evaluates the clinical and renal-related outcomes in patients with acute renal failure (ARF) following cardiac surgery. METHODS Index adult cardiac operations at a single institution from 2010-2018 were reviewed. Patients requiring dialysis pre-operatively were excluded. ARF was stratified as either creatinine rise (≥3-times baseline or ≥4.0 mg/dL) or post-operative dialysis. Outcomes included mortality, rates of progression to dialysis, and renal recovery. Multivariable Cox regression was used for risk-adjustment. RESULTS A total of 10,037 patients, including 6,275 (62.5%) isolated coronary artery bypass grafting (CABG), 2,243 (22.3%) isolated valve, and 1,519 (15.1%) CABG plus valve cases, were included. Post-operative ARF occurred in 346 (3.5%) patients, with 230 (66.5%) requiring dialysis. Survival was significantly reduced in patients with ARF at 30-days (97.9 versus 70.8%, P <0.001), 1-year (94.9 versus 48.0%, P <0.001), and 5-years (86.2 versus 38.2%, P <0.001) with more profound reductions in those requiring dialysis, findings which persisted after risk-adjustment. Progression to subsequent dialysis in the creatinine rise group was rare (n = 1). The median time to dialysis initiation in the dialysis group was 5 days (IQR 2-12 days) with a median time of dialysis dependence of 72 days (IQR 38-1229 days). Of those patients requiring postoperative dialysis, 30.9% demonstrated renal recovery. CONCLUSIONS Post-operative ARF and in particular the need for dialysis are associated with substantial reductions in survival that persist during longitudinal follow-up. This occurs despite the finding that patients experiencing creatinine rise only rarely progress to dialysis, and that nearly one-third of patients requiring post-operative dialysis recover renal function.
Collapse
Affiliation(s)
- Lauren V Huckaby
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Laura M Seese
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Nicholas Hess
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Edgar Aranda-Michel
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ibrahim Sultan
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Thomas G Gleason
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Danny Chu
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Yisi Wang
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Floyd Thoma
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Arman Kilic
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
| |
Collapse
|
38
|
Assessment of 17 clinically available renal biomarkers to predict acute kidney injury in critically ill patients. J Transl Int Med 2021; 9:273-284. [PMID: 35136726 PMCID: PMC8802406 DOI: 10.2478/jtim-2021-0047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
ABSTRACT
Background:
Systematic estimation of renal biomarkers in the intensive care unit (ICU) patients is lacking. Seventeen biomarkers were assessed to predict acute kidney injury (AKI) after admission to ICU.
Materials and methods:
A prospective, observational study was conducted in the general ICU of Guangdong Provincial People’s Hospital. Seventeen serum or urine biomarkers were studied for their abilities alone or in combination for predicting AKI and severe AKI.
Results:
Of 1498 patients, 376 (25.1%) developed AKI. Serum cystatin C (CysC) showed the best performance for predicting both AKI (area under the receiver operator characteristic curve [AUC] = 0.785, mean square error [MSE] = 0.118) and severe AKI (AUC = 0.883, MSE = 0.06). Regarding biomarkers combinations, CysC plus N-acetyl-β-d-glucosaminidase-to-creatinine ratio (NAG/Cr) was the best for predicting AKI (AUC = 0.856, MSE = 0.21). At the same time, CysC plus lactic acid (LAC) performed the best for predicting severe AKI (AUC = 0.907, MSE = 0.058). Regarding combinations of biomarkers and clinical markers, CysC plus Acute Physiology and Chronic Health Evaluation (APACHE) II score showed the best performance for predicting AKI (AUC = 0.868, MSE = 0.407). In contrast, CysC plus Multiple Organ Dysfunction Score (MODS) had the highest predictive ability for severe AKI (AUC = 0.912, MSE = 0.488).
Conclusion:
Apart from CysC, the combination of most clinically available biomarkers or clinical markers does not significantly improve the forecasting ability, and the cost–benefit ratio is not economical.
Collapse
|
39
|
Tao X, Chen C, Luo W, Zhou J, Tian J, Yang X, Hou FF. Combining renal cell arrest and damage biomarkers to predict progressive AKI in patient with sepsis. BMC Nephrol 2021; 22:415. [PMID: 34906098 PMCID: PMC8672478 DOI: 10.1186/s12882-021-02611-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 11/16/2021] [Indexed: 12/29/2022] Open
Abstract
Background Sepsis is the most common trigger for AKI and up to 40% of mild or moderate septic AKI would progress to more severe AKI, which is associated with significantly increased risk for death and later CKD/ESRD. Early identifying high risk patients for AKI progression is a major challenge in patients with septic AKI. Methods This is a prospective, multicenter cohort study which enrolled adult patients with sepsis and initially developed stage 1 or 2 AKI in the intensive care unit from January 2014 to March 2018. AKI was diagnosed and staged according to 2012 KDIGO-AKI guidelines. Renal cell arrest biomarkers (urinary TIMP2*IGFBP7, u[TIMP-2]*[IGFBP7]) and renal damage biomarkers (urinary KIM-1[uKIM-1] and urinary IL-18 [uIL-18]) were measured at time of AKI clinical diagnosis, and the performance of biomarkers for predicting septic AKI progression alone or in combination were evaluated. The primary outcome was AKI progression defined as worsening of AKI stage. The secondary outcome was AKI progression with subsequent death during hospitalization. Results Among 433 screened patients, 149 patients with sepsis and stage 1 or 2 AKI were included, in which 63 patients developed progressive AKI and 49 patients subsequently died during hospitalization. u[TIMP-2]*[IGFBP7], uKIM-1 and uIL-18 independently predicted the progression of septic AKI in which u[TIMP-2]*[IGFBP7] showed the greatest AUC (0.745; 95%CI, 0.667-0.823) as compared to uKIM-1 (AUC 0.719; 95%CI 0.638-0.800) and uIL-18 (AUC 0.619; 95%CI 0.525-0.731). Combination of u[TIMP-2]*[IGFBP7] with uKIM-1 improved the performance of predicting septic AKI progression with AUC of 0.752. u[TIMP-2]*[IGFBP7], alone or combined with uKIM-1/uIL-18, improved the risk reclassification over the clinical risk factor model alone both for the primary and secondary outcomes, as evidenced by significant category-free net reclassification index. Conclusions Combination of renal cell arrest and damage biomarkers enhanced the prediction of AKI progression in patients with sepsis and improved risk reclassification over the clinical risk factors. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-021-02611-8.
Collapse
Affiliation(s)
- Xiaolei Tao
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Clinical Research Center for Kidney Disease, Guangzhou Regenerative Medicine and Health-Guangdong Laboratory, 1838 North Guangzhou Ave, Guangzhou, 510515, China
| | - Chunbo Chen
- Department of Intensive Care Unit of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Laboratory of South China Structural Heart Disease, Department of Critical Care Medicine, Guangdong Provincial People's Hospital, Academy of Medical Sciences, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510000, Guangdong, China
| | - Weihong Luo
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Clinical Research Center for Kidney Disease, Guangzhou Regenerative Medicine and Health-Guangdong Laboratory, 1838 North Guangzhou Ave, Guangzhou, 510515, China
| | - Jing Zhou
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Clinical Research Center for Kidney Disease, Guangzhou Regenerative Medicine and Health-Guangdong Laboratory, 1838 North Guangzhou Ave, Guangzhou, 510515, China
| | - Jianwei Tian
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Clinical Research Center for Kidney Disease, Guangzhou Regenerative Medicine and Health-Guangdong Laboratory, 1838 North Guangzhou Ave, Guangzhou, 510515, China
| | - Xiaobing Yang
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Clinical Research Center for Kidney Disease, Guangzhou Regenerative Medicine and Health-Guangdong Laboratory, 1838 North Guangzhou Ave, Guangzhou, 510515, China.
| | - Fan Fan Hou
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Clinical Research Center for Kidney Disease, Guangzhou Regenerative Medicine and Health-Guangdong Laboratory, 1838 North Guangzhou Ave, Guangzhou, 510515, China.
| |
Collapse
|
40
|
CSA-AKI: Incidence, Epidemiology, Clinical Outcomes, and Economic Impact. J Clin Med 2021; 10:jcm10245746. [PMID: 34945041 PMCID: PMC8706363 DOI: 10.3390/jcm10245746] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/01/2021] [Accepted: 12/05/2021] [Indexed: 12/13/2022] Open
Abstract
Cardiac surgery-associated acute kidney injury (CSA-AKI) is a common complication following cardiac surgery and reflects a complex biological combination of patient pathology, perioperative stress, and medical management. Current diagnostic criteria, though increasingly standardized, are predicated on loss of renal function (as measured by functional biomarkers of the kidney). The addition of new diagnostic injury biomarkers to clinical practice has shown promise in identifying patients at risk of renal injury earlier in their course. The accurate and timely identification of a high-risk population may allow for bundled interventions to prevent the development of CSA-AKI, but further validation of these interventions is necessary. Once the diagnosis of CSA-AKI is established, evidence-based treatment is limited to supportive care. The cost of CSA-AKI is difficult to accurately estimate, given the diverse ways in which it impacts patient outcomes, from ICU length of stay to post-hospital rehabilitation to progression to CKD and ESRD. However, with the global rise in cardiac surgery volume, these costs are large and growing.
Collapse
|
41
|
Maltseva LD, Lakomova DY, Zakharova NB, Gurova TS, Morozova OL. Potential targets for preclinical diagnostics of acute kidney injury in covid-19 patients (review of literature). Klin Lab Diagn 2021; 66:586-592. [PMID: 34665944 DOI: 10.51620/0869-2084-2021-66-10-586-592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
An relevance of the topic was defined by the high occurrence, unfavorable prognosis, lack of diagnostic techniques for early stages of acute kidney injury (AKI) disclosed in patients with COVID-19 (Coronavirus Disease 2019). Screening of medical literature for selection of AKI preclinical biomarkers was considered as main aim of this review. More than 200 publications from Russian Science Citation Index (RSCI), Scopus, The Cochrane Library, and MEDLINE were reviewed. Such risk factors as hypoxemia, increased intrathoracic pressure associated with Acute Respiratory Distress Syndrome (ARDS), hypertension (HT) involving endothelial dysfunction, and Diabetes mellitus were considered to be associated with AKI. There were explicated cytopathic and immune-mediated (cytokine-induced) mechanisms of COVID-19 associated AKI pathogenesis. Multiple methodological approaches were defined for detection and identification of the biomarkers based on urine proteome and metabolome screening. Perspective ways in the preclinical diagnostics of AKI such as detection of the markers of injury of the hypoxia-sensitive proximal canaliculi and the ATP metabolites that reflect first stages of the energy metabolism disorder in the epithelium lining canaliculi were identified in this study. The instantaneous and non-invasive investigation of different markers was regarded as possible method of the prognostication. The accuracy of the diagnosis on the initial stages of AKI, substantiate for preventive start of therapy, and make projections on the disease`s outcome will be improved due to the identification of high-sensitive specific biomarkers.
Collapse
Affiliation(s)
- L D Maltseva
- I.M. Sechenov First Moscow State Medical University
| | - D Y Lakomova
- V.I. Razumovsky Saratov State Medical University
| | | | - T S Gurova
- I.M. Sechenov First Moscow State Medical University
| | - O L Morozova
- I.M. Sechenov First Moscow State Medical University
| |
Collapse
|
42
|
Risk factors for acute kidney injury following coronary artery bypass graft surgery in a Chinese population and development of a prediction model. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2021; 18:711-719. [PMID: 34659377 PMCID: PMC8501387 DOI: 10.11909/j.issn.1671-5411.2021.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) after coronary artery bypass graft (CABG) surgery is associated with significant morbidity and mortality. This retrospective study aimed to establish a risk score for postoperative AKI in a Chinese population. METHODS A total of 1138 patients undergoing CABG were collected from September 2018 to May 2020 and divided into a derivation and validation cohort. AKI was defined according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Multivariable logistic regression analysis was used to determine the independent predictors of AKI, and the predictive ability of the model was determined using a receiver operating characteristic (ROC) curve. RESULTS The incidence of cardiac surgery–associated acute kidney injury (CSA-AKI) was 24.17%, and 0.53% of AKI patients required dialysis (AKI-D). Among the derivation cohort, multivariable logistic regression showed that age ≥ 70 years, body mass index (BMI) ≥ 25 kg/m2, estimated glomerular filtration rate (eGFR) ≤ 60 mL/min per 1.73 m2, ejection fraction (EF) ≤ 45%, use of statins, red blood cell transfusion, use of adrenaline, intra-aortic balloon pump (IABP) implantation, postoperative low cardiac output syndrome (LCOS) and reoperation for bleeding were independent predictors. The predictive model was scored from 0 to 32 points with three risk categories. The AKI frequencies were as follows: 0−8 points (15.9%), 9−17points (36.5%) and ≥ 18 points (90.4%). The area under of the ROC curve was 0.730 (95% CI: 0.691−0.768) in the derivation cohort. The predictive index had good discrimination in the validation cohort, with an area under the curve of 0.735 (95% CI: 0.655−0.815). The model was well calibrated according to the Hosmer-Lemeshow test (P = 0.372).
CONCLUSION The performance of the prediction model was valid and accurate in predicting KDIGO-AKI after CABG surgery in Chinese patients, and could improve the early prognosis and clinical interventions.
Collapse
|
43
|
Amatruda JG, Estrella MM, Garg AX, Thiessen-Philbrook H, McArthur E, Coca SG, Parikh CR, Shlipak MG. Urine Alpha-1-Microglobulin Levels and Acute Kidney Injury, Mortality, and Cardiovascular Events following Cardiac Surgery. Am J Nephrol 2021; 52:673-683. [PMID: 34515046 DOI: 10.1159/000518240] [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: 04/15/2021] [Accepted: 05/20/2021] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Urine alpha-1-microglobulin (Uα1m) elevations signal proximal tubule dysfunction. In ambulatory settings, higher Uα1m is associated with acute kidney injury (AKI), progressive chronic kidney disease (CKD), cardiovascular (CV) events, and mortality. We investigated the associations of pre- and postoperative Uα1m concentrations with adverse outcomes after cardiac surgery. METHODS In 1,464 adults undergoing cardiac surgery in the prospective multicenter Translational Research Investigating Biomarker Endpoints for Acute Kidney Injury (TRIBE-AKI) cohort, we measured the pre-and postoperative Uα1m concentrations and calculated the changes from pre- to postoperative concentrations. Outcomes were postoperative AKI during index hospitalization and longitudinal risks for CKD incidence and progression, CV events, and all-cause mortality after discharge. We analyzed Uα1m continuously and categorically by tertiles using multivariable logistic regression and Cox proportional hazards regression adjusted for demographics, surgery characteristics, comorbidities, baseline estimated glomerular filtration rate, urine albumin, and urine creatinine. RESULTS There were 230 AKI events during cardiac surgery hospitalization; during median 6.7 years of follow-up, there were 212 cases of incident CKD, 54 cases of CKD progression, 269 CV events, and 459 deaths. Each 2-fold higher concentration of preoperative Uα1m was independently associated with AKI (adjusted odds ratio [aOR] = 1.36, 95% confidence interval 1.14-1.62), CKD progression (adjusted hazard ratio [aHR] = 1.46, 1.04-2.05), and all-cause mortality (aHR = 1.19, 1.06-1.33) but not with incident CKD (aHR = 1.21, 0.96-1.51) or CV events (aHR = 1.01, 0.86-1.19). Postoperative Uα1m was not associated with AKI (aOR per 2-fold higher = 1.07, 0.93-1.22), CKD incidence (aHR = 0.90, 0.79-1.03) or progression (aHR = 0.79, 0.56-1.11), CV events (aHR = 1.06, 0.94-1.19), and mortality (aHR = 1.01, 0.92-1.11). CONCLUSION Preoperative Uα1m concentrations may identify patients at high risk of AKI and other adverse events after cardiac surgery, but postoperative Uα1m concentrations do not appear to be informative.
Collapse
Affiliation(s)
- Jonathan G Amatruda
- Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA,
- Kidney Health Research Collaborative, San Francisco VA Health Care System & University of California, San Francisco, San Francisco, California, USA,
| | - Michelle M Estrella
- Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Kidney Health Research Collaborative, San Francisco VA Health Care System & University of California, San Francisco, San Francisco, California, USA
- Division of Nephrology, Department of Medicine, San Francisco VA Health Care System, San Francisco, California, USA
| | - Amit X Garg
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | | | | | - Steven G Coca
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Chirag R Parikh
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael G Shlipak
- Kidney Health Research Collaborative, San Francisco VA Health Care System & University of California, San Francisco, San Francisco, California, USA
- Department of Medicine, San Francisco VA Health Care System, San Francisco, California, USA
| |
Collapse
|
44
|
Duff S, Irwin R, Cote JM, Redahan L, McMahon BA, Marsh B, Nichol A, Holden S, Doran P, Murray PT. Urinary biomarkers predict progression and adverse outcomes ofacute kidney injury in critical illness. Nephrol Dial Transplant 2021; 37:1668-1678. [PMID: 34491355 DOI: 10.1093/ndt/gfab263] [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: 05/10/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Acute Kidney Injury (AKI) is common in hospitalized patients and is associated with high morbidity and mortality. The Dublin Acute Biomarker Group Evaluation (DAMAGE) Study is a prospective cohort study of critically ill patients (n = 717). We hypothesised that novel urinary biomarkers would predict progression of AKI and associated outcomes. METHODS The primary (diagnostic) analysis assessed the ability of biomarkers levels at the time of early Stage 1 or2 AKI to predict progression to higher AKI Stage, RRT or Death within 7 days of ICU admission. In the secondary (prognostic) analysis, we investigated the association between biomarker levels and RRT or Death within 30 days. RESULTS In total, 186 patients had an AKI within 7 days of admission. In the primary (diagnostic) analysis, eight of the 14 biomarkers were independently associated with progression. The best predictors were Cystatin C (aOR 5.2; 95% CI, 1.3-23.6), IL-18 (aOR 5.1; 95% CI, 1.8-15.7), Albumin (aOR 4.9; 95% CI, 1.5-18.3) and NGAL (aOR 4.6; 95% CI, 1.4-17.9). ROC and Net Reclassification Index analyses similarly demonstrated improved prediction by these biomarkers. In the secondary (prognostic) analysis of Stage 1-3 AKI cases, IL-18, NGAL, Albumin, and MCP-1 were also independently associated with RRT or Death within 30 days. CONCLUSIONS Among 14 novel urinary biomarkers assessed, Cystatin C, IL-18, Albumin and NGAL were the best predictors of Stage 1-2 AKI progression. These biomarkers, after further validation, may have utility to inform diagnostic and prognostic assessment and guide management of AKI in critically ill patients.
Collapse
Affiliation(s)
- Stephen Duff
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Ruairi Irwin
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Jean Maxime Cote
- School of Medicine, University College Dublin, Dublin, Ireland.,Division of Nephrology, Centre hospitalier de l, 'Université de Montréal, Montreal, Canada
| | - Lynn Redahan
- Division of Nephrology, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Brian Marsh
- Department of Intensive Care Medicine, University College Dublin, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Alistair Nichol
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Sinead Holden
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Peter Doran
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Patrick T Murray
- School of Medicine, University College Dublin, Dublin, Ireland.,Division of Nephrology, Mater Misericordiae University Hospital, Dublin, Ireland
| |
Collapse
|
45
|
Ostermann M, Karsten E, Lumlertgul N. Biomarker-Based Management of AKI: Fact or Fantasy? Nephron Clin Pract 2021; 146:295-301. [PMID: 34515152 PMCID: PMC9216309 DOI: 10.1159/000518365] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/15/2021] [Indexed: 11/19/2022] Open
Abstract
New biomarkers for acute kidney injury (AKI) have improved our understanding of the etiology and pathogenesis of AKI. Depending on their origin, function, and kinetic profile, biomarkers have a role in screening, diagnosis, prognostication, and monitoring of AKI. This offers opportunities to improve the management of AKI, but concerns and limitations remain. In this review, we summarize the current role of new AKI biomarkers in the management of AKI and outline some of the ongoing limitations and challenges.
Collapse
Affiliation(s)
- Marlies Ostermann
- Department of Critical Care, King's College London, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Emma Karsten
- Emergency Department, Guy's & St Thomas' Foundation Trust, London, United Kingdom
| | - Nuttha Lumlertgul
- Department of Critical Care, King's College London, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
- Division of Nephrology, Department of Internal Medicine and Excellence Center in Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Research Unit in Critical Care Nephrology, Chulalongkorn University, Bangkok, Thailand
| |
Collapse
|
46
|
Assessment and Prognosis in CSA-AKI Using Novel Kidney Injury Biomarkers: A Prospective Observational Study. BIOLOGY 2021; 10:biology10090823. [PMID: 34571700 PMCID: PMC8470477 DOI: 10.3390/biology10090823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/16/2021] [Accepted: 08/18/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is a need for early diagnostic solutions for cardiac surgery associated acute kidney injury (CSA-AKI) as serum creatinine changes do not occur dynamically enough. Moreover, new approaches are needed for kidney protective strategy in patients undergoing cardiac surgery procedures; Methods: Samples of serum and urine were taken from the selected group of patients undergoing elective cardiac surgery procedures. The aim of this study was to assess the utility of specific inflammation and kidney injury biomarkers in the early diagnostic of CSA-AKI and in the prognosis of long-term postoperative kidney function; Results: At 6 h after weaning from cardiopulmonary bypass, there were significant differences in IL-6, IL-8, TNF-α, MMP-9 and NGAL concentrations in patients with CSA-AKI, compared to the control group. Serum IL-8 and urine NGAL 6 h after weaning from CPB proved to be independent acute kidney injury predictors. The TNF-α, MMP-9, IL-18, TIMP-1 and MMP-9/TIMP-1 ratio in the early postoperative period correlated with long-term kidney function impairment; Conclusions: Novel kidney injury biomarkers are an eligible tool for early diagnosis of CSA-AKI. They are also reliable indicators of long-term postoperative kidney function impairment risk after cardiac surgery procedures.
Collapse
|
47
|
Lee HA, Seo YS. Current knowledge about biomarkers of acute kidney injury in liver cirrhosis. Clin Mol Hepatol 2021; 28:31-46. [PMID: 34333958 PMCID: PMC8755473 DOI: 10.3350/cmh.2021.0148] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 07/28/2021] [Indexed: 11/05/2022] Open
Abstract
Acute kidney injury (AKI) is common in advanced cirrhosis. Prerenal azotemia, hepatorenal syndrome, and acute tubular necrosis are the main causes of AKI in patients with cirrhosis. Evaluation of renal function and differentiation between functional and structural kidney injury are important issues in the management of cirrhosis. However, AKI in cirrhosis exists as a complex clinical spectrum rather than concrete clinical entity. Based on current evidence, changes in serum creatinine (Cr) levels remain the most appropriate standard for defining AKI in cirrhosis. However, serum Cr has a limited role in assessing renal function in this population. This review examines previous studies that investigated the ability of recent biomarkers for AKI in cirrhosis from the perspective of earlier and accurate diagnosis, classification of AKI phenotype, and prediction of clinical outcomes. Serum cystatin C and urine neutrophil gelatinase-associated lipocalin have been extensively studied in cirrhosis, and have facilitated improved diagnosis and prognosis prediction in patients with AKI. In addition, urine N-acetyl-β-D-glucosaminidase, interleukin 18, and kidney injury molecule 1 are other promising biomarkers for advanced cirrhosis. However, the clinical significance of these markers remains unclear because there are no cut-off values defining the normal range and differentiating phenotypes of AKI. In addition, AKI has been defined in terms of serum Cr, and renal biopsy-the gold standard-has not been carried out in most studies. Further discovery of innovate biomarkers and incorporation of various markers could improve the diagnosis and prognosis prediction of AKI, and will translate into meaningful improvements in patient outcomes.
Collapse
Affiliation(s)
- Han Ah Lee
- Departments of Internal Medicine, Korea University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Yeon Seok Seo
- Departments of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| |
Collapse
|
48
|
Chang CY, Chien YJ, Kao MC, Lin HY, Chen YL, Wu MY. Pre-operative proteinuria, postoperative acute kidney injury and mortality: A systematic review and meta-analysis. Eur J Anaesthesiol 2021; 38:702-714. [PMID: 34101638 DOI: 10.1097/eja.0000000000001542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To investigate the association of pre-operative proteinuria with postoperative acute kidney injury (AKI) development as well as the requirement for a renal replacement therapy (RRT) and mortality at short-term and long-term follow-up. BACKGROUND Postoperative AKI is associated with surgical morbidity and mortality. Pre-operative proteinuria is potentially a risk factor for postoperative AKI and mortality. However, the results in literature are conflicting. METHODS We searched PubMed, Embase, Scopus, Web of Science and Cochrane Library from the inception through to 3 June 2020. Observational cohort studies investigating the association of pre-operative proteinuria with postoperative AKI development, requirement for RRT, and all-cause mortality at short-term and long-term follow-up were considered eligible. Using inverse variance method with a random-effects model, the pooled effect estimates and 95% confidence interval (CI) were calculated. RESULTS Twenty-eight studies were included. Pre-operative proteinuria was associated with postoperative AKI development [odds ratio (OR) 1.74, 95% CI, 1.45 to 2.09], in-hospital RRT (OR 1.70, 95% CI, 1.25 to 2.32), requirement for RRT at long-term follow-up [hazard ratio (HR) 3.72, 95% CI, 2.03 to 6.82], and long-term all-cause mortality (hazard ratio 1.50, 95% CI, 1.30 to 1.73). In the subgroup analysis, pre-operative proteinuria was associated with increased odds of postoperative AKI in both cardiovascular (OR 1.77, 95% CI, 1.47 to 2.14) and noncardiovascular surgery (OR 1.63, 95% CI, 1.01 to 2.63). Moreover, there is a stepwise increase in OR of postoperative AKI development when the quantity of proteinuria increases from trace to 3+. CONCLUSION Pre-operative proteinuria is significantly associated with postoperative AKI and long-term mortality. Pre-operative anaesthetic assessment should take into account the presence of proteinuria to identify high-risk patients. PROSPERO REGISTRATION CRD42020190065.
Collapse
Affiliation(s)
- Chun-Yu Chang
- From the Department of Anesthesiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City (C-YC, M-CK, H-YL), Department of Anesthesiology, School of Medicine, Tzu Chi University, Hualien (C-YC, M-CK, H-YL), Department of Physical Medicine and Rehabilitation, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City (Y-JC), Department of Physical Medicine and Rehabilitation, School of Medicine, Tzu Chi University, Hualien (Y-JC), Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City (Y-LC, M-YW) and Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien, Taiwan (Y-LC, M-YW)
| | | | | | | | | | | |
Collapse
|
49
|
Du Y, Wang XZ, Wu WD, Shi HP, Yang XJ, Wu WJ, Chen SX. Predicting the Risk of Acute Kidney Injury in Patients After Percutaneous Coronary Intervention (PCI) or Cardiopulmonary Bypass (CPB) Surgery: Development and Assessment of a Nomogram Prediction Model. Med Sci Monit 2021; 27:e929791. [PMID: 33895770 PMCID: PMC8083792 DOI: 10.12659/msm.929791] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background We sought to create a model that incorporated ultrasound examinations to predict the risk of acute kidney injury (AKI) after percutaneous coronary intervention (PCI) or cardiopulmonary bypass (CPB) surgery. Material/Methods A total of 292 patients with AKI after PCI or CPB surgery were enrolled for the study. Afterwards, treatment-related information, including data pertaining to ultrasound examination, was collected. A random forest model and multivariate logistic regression analysis were then used to establish a predictive model for the risk of AKI. Finally, the predictive quality and clinical utility of the model were assessed using calibration plots, receiver-operating characteristic curve, C-index, and decision curve analysis. Results Predictive factors were screened and the model was established with a C-index of 0.955 in the overall sample set. Additionally, an area under the curve of 0.967 was obtained in the training group. Moreover, decision curve analysis also revealed that the prediction model had good clinical applicability. Conclusions The prediction model was efficient in predicting the risk of AKI by incorporating ultrasound examinations and a number of factors. Such included operation methods, age, congestive heart failure, body mass index, heart rate, white blood cell count, platelet count, hemoglobin, uric acid, and peak intensity (kidney cortex as well as kidney medulla).
Collapse
Affiliation(s)
- Yi Du
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, Shanxi, China (mainland)
| | - Xiu-Zhe Wang
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, Shanxi, China (mainland)
| | - Wei-Dong Wu
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, Shanxi, China (mainland)
| | - Hai-Peng Shi
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, Shanxi, China (mainland)
| | - Xiao-Jing Yang
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, Shanxi, China (mainland)
| | - Wen-Jing Wu
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, Shanxi, China (mainland)
| | - Shu-Xian Chen
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, Shanxi, China (mainland)
| |
Collapse
|
50
|
Chen JJ, Lee TH, Lee CC, Chang CH. Using lipocalin as a prognostic biomarker in acute kidney injury. Expert Rev Mol Diagn 2021; 21:455-464. [PMID: 33874823 DOI: 10.1080/14737159.2021.1917384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction: Human lipocalin-2, known as neutrophil gelatinase-associated lipocalin (NGAL), is a widely studied biomarker of acute kidney injury (AKI).Areas covered: NGAL can serve as a predictor of AKI, disease progression, and mortality and can help in differentiating between AKI etiologies. We conducted a systematic review in the PubMed and Medline databases involving the clinical application of NGAL in patients with AKI.Expert opinion: In this review, we explored the usefulness of NGAL for AKI or clinical outcome prediction. The use of urine or blood NGAL levels alone or in combination with a clinical prediction model may facilitate AKI prediction, severity prediction, AKI etiological differentiation, and mortality prediction. For AKI prediction, urine and plasma NGAL levels have an area under the curve (AUC) ranging from 0.71 to 0.90 and from 0.71 to 0.89, respectively, in different populations. The diagnostic performance of NGAL alone for renal replacement therapy or successful discontinuation prediction is suboptimal (AUC range: 0.65-0.81). Sepsis limits the application of NGAL as a clinical predictor, and the prediction performance of NGAL is affected by baseline renal function, timing of sample collection, and underlying comorbidities. The lack of internationally approved reference material also limits the usefulness of NGAL.
Collapse
Affiliation(s)
- Jia-Jin Chen
- Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Tao-Han Lee
- Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Cheng-Chia Lee
- Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan.,Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Chih-Hsiang Chang
- Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan.,Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Taipei, Taiwan
| |
Collapse
|