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Limonte CP, Gao X, Bebu I, Seegmiller JC, Lorenzi GM, Perkins BA, Karger AB, Arends VL, Paterson A, Molitch ME, de Boer IH. Longitudinal Trajectories of Biomarkers of Kidney Tubular Function in Type 1 Diabetes. Kidney Int Rep 2024; 9:1406-1418. [PMID: 38707816 PMCID: PMC11068962 DOI: 10.1016/j.ekir.2023.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/06/2023] [Indexed: 05/07/2024] Open
Abstract
Introduction Tubular biomarkers may shed insight into progression of kidney tubulointerstitial pathology complementary to traditional measures of glomerular function and damage. Methods We examined trajectories of tubular biomarkers in the Diabetes Control and Complications Trial and the Epidemiology of Diabetes Interventions and Complications Study (DCCT/EDIC Study) of type 1 diabetes (T1D). Biomarkers were measured in a subset of 220 participants across 7 time points over 26 years. Measurements included the following: kidney injury molecule 1 (KIM-1), soluble tumor necrosis factor 1 (sTNFR1) in serum or plasma, epidermal growth factor (EGF), monocyte chemoattractant protein-1 (MCP1) in timed urine, and a composite tubular secretion score. We described biomarker trajectories and examined how these were affected by intensive glucose-lowering therapy and glycemia. Results At baseline, participants had a mean age of 28 years, 45% were women, and 50% were assigned to intensive glucose-lowering therapy. The mean estimated glomerular filtration rate (eGFR) was 125 ml/min per 1.73 m2 and 90% of participants had a urinary albumin excretion rate (AER) <30 mg/24h. Mean changes in biomarkers over time (percent/decade) were: KIM-1: 27.3% (95% confidence interval [CI]: 21.4-33.5), sTNFR1: 16.9% (14.5-19.3), MCP1: 18.4% (8.9-28.8), EGF: -13.5% (-16.7 to -10.1), EGF-MCP1 ratio: -26.9% (-32.2 to -21.3), and tubular secretion score -0.9% (-1.8 to 0.0), versus -12.0% (CI: -12.9 to -11.1) for eGFR and 10.9% (2.5-20.1) for AER. Intensive versus conventional glucose-lowering therapy was associated with slower increase in sTNFR1 (relative difference in change: 0.94 [0.90-0.98]). Higher HbA1c was associated with faster increases in sTNFR1 (relative difference in change: 1.06 per 1% higher HbA1c [1.05-1.08]) and KIM-1 (1.09 [1.05-1.14]). Conclusion Among participants with T1D and normal eGFR at baseline, kidney tubular biomarkers changed significantly over long-term follow-up. Hyperglycemia was associated with larger increases in serum or plasma sTNFR1 and KIM-1, when followed-up longitudinally.
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Affiliation(s)
- Christine P. Limonte
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington, USA
- Kidney Research Institute, University of Washington, Seattle, Washington, USA
| | - Xiaoyu Gao
- Biostatistics Center, The George Washington University, Rockville, Maryland, USA
| | - Ionut Bebu
- Biostatistics Center, The George Washington University, Rockville, Maryland, USA
| | - Jesse C. Seegmiller
- Department of Laboratory Medicine and Pathology, School of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Gayle M. Lorenzi
- Department of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Bruce A. Perkins
- Division of Endocrinology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Amy B. Karger
- Department of Laboratory Medicine and Pathology, School of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Valerie L. Arends
- Department of Laboratory Medicine and Pathology, School of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Andrew Paterson
- Program in Genetics and Genome Biology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Mark E. Molitch
- Division of Endocrinology, Metabolism, and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ian H. de Boer
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington, USA
- Kidney Research Institute, University of Washington, Seattle, Washington, USA
| | - DCCT/EDIC Research Group9
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington, USA
- Kidney Research Institute, University of Washington, Seattle, Washington, USA
- Biostatistics Center, The George Washington University, Rockville, Maryland, USA
- Department of Laboratory Medicine and Pathology, School of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Medicine, University of California, San Diego, La Jolla, California, USA
- Division of Endocrinology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Program in Genetics and Genome Biology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Division of Endocrinology, Metabolism, and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Wang Z, Xu J, Zhang Y, Chen C, Kong C, Tang L, Jiang Y, Yu R, Zong Q, Zhang L, Wang D. Prediction of acute kidney injury incidence following acute type A aortic dissection surgery with novel biomarkers: a prospective observational study. BMC Med 2023; 21:503. [PMID: 38110934 PMCID: PMC10729328 DOI: 10.1186/s12916-023-03215-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/05/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is a prevalent complication following acute type A aortic dissection (ATAAD) surgery and is closely associated with unfavorable prognostic outcomes. Hence, the development of a robust and efficient diagnostic approach to identify high-risk patients is of paramount importance. METHODS We conducted a prospective study involving 328 patients who underwent ATAAD surgery at our institution, comprising three distinct cohorts. In addition, 52 patients undergoing alternative cardiopulmonary surgeries and 37 healthy individuals were enrolled as control groups. Employing proteomic analysis, we initially identified plasma proteins potentially linked to AKI occurrence within the plasma proteomic cohort. Subsequent validation was performed in an independent cohort. Utilizing predictors derived from multivariate logistic regression analysis, a nomogram was meticulously formulated and its efficacy was validated in the model construction cohort. RESULTS Proteomics revealed significant elevation of plasma levels of S100A8/A9, pentraxin 3 (PTX3), and chitinase 3-like 1 (CHI3L1) immediately post-surgery in patients who developed ATAAD surgery-associated AKI (ASA-AKI). Receiver operating characteristic (ROC) curves demonstrated impressive predictive performance of S100A8/A9, PTX3, and CHI3L1 at 0 h post-surgery, yielding area under the curve (AUC) values of 0.823, 0.786, and 0.803, respectively, for ASA-AKI prediction. Furthermore, our findings exhibited positive correlations between plasma levels of S100A8/A9, PTX3, CHI3L1, and urinary neutrophil gelatinase-associated lipocalin (NGAL) at 0 h post-surgery, along with correlations between plasma S100A8/A9, CHI3L1 levels, and the Cleveland Clinic score. A logistic regression model incorporating plasma S100A8/A9, PTX3, CHI3L1 levels, urinary NGAL levels, and the Cleveland Clinic score facilitated the construction of a predictive nomogram for ASA-AKI. This nomogram demonstrated robust discriminative ability, achieving an AUC of 0.963 in the model construction cohort. CONCLUSIONS Our study underscored the augmentation of plasma S100A8/A9, PTX3, and CHI3L1 levels immediately post-surgery in patients developing ASA-AKI. The incorporation of these three biomarkers, in conjunction with the Cleveland Clinic score and NGAL, into a nomogram demonstrated commendable predictive efficacy. This presents a practical tool for identifying patients at an elevated risk of AKI following ATAAD surgery.
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Affiliation(s)
- Zhigang Wang
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Jingfang Xu
- Department of Nephrology, Ningbo First Hospital, Ningbo, China
| | - Yu Zhang
- Department of Pharmacology, College of Pharmacy, Harbin Medical University, Harbin, China
| | - Cheng Chen
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Chuiyu Kong
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Lu Tang
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Yi Jiang
- Department of Cardiovascular Surgery, Nanjing Drum Tower Hospital, Chinese Academy of Medical Science & Peking Union Medical, Beijing, China
| | - Ronghuang Yu
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Qiuyan Zong
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Lifang Zhang
- Department of Psychiatry, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - Dongjin Wang
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
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Gudsoorkar PS, Nysather J, Thakar CV. Definition, Staging, and Role of Biomarkers in Acute Kidney Injury in the Context of Cardiovascular Interventions. Interv Cardiol Clin 2023; 12:469-487. [PMID: 37673492 DOI: 10.1016/j.iccl.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Acute kidney injury (AKI) is a frequently occurring complication of cardiovascular interventions, and associated with adverse outcomes. Therefore, a clear definition of AKI is of paramount importance to enable timely recognition and treatment. Historically, changes in the serum creatinine and urine output have been used to define AKI, and the criteria have evolved over time with better understanding of the impact of AKI on the outcomes. However, the reliance on serum creatinine for these AKI definitions carries numerous limitations including delayed rise, inability to differentiate between hemodynamics versus structural injury and assay variability to name a few.
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Affiliation(s)
- Prakash S Gudsoorkar
- Division of Nephrology and Kidney CARE Program, Department of Medicine, University of Cincinnati, OH, USA; Division of Nephrology and Kidney Clinical Advancement, Research & Education (C.A.R.E.) Program, University of Cincinnati, 231 Albert Sabin Way, OH 45267, USA.
| | - Jacob Nysather
- Division of Nephrology and Kidney CARE Program, Department of Medicine, University of Cincinnati, OH, USA; Division of Nephrology and Kidney Clinical Advancement, Research & Education (C.A.R.E.) Program, University of Cincinnati, 231 Albert Sabin Way, OH 45267, USA
| | - Charuhas V Thakar
- Division of Nephrology and Kidney CARE Program, Department of Medicine, University of Cincinnati, OH, USA; Division of Nephrology and Kidney Clinical Advancement, Research & Education (C.A.R.E.) Program, University of Cincinnati, 231 Albert Sabin Way, OH 45267, USA; Department of Nephrology, Veterans Administration Medical Center, Cincinnati, OH, USA
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Lang H, Zhang H, Ma M, Wan X, Chen Y, Sun Q, Cao C. Serum Fstl1, a novel biomarker screened based on protein array technology, predict acute kidney injury and major renal adverse events after cardiac surgery: A prospective cohort study. Clin Chim Acta 2023; 539:79-86. [PMID: 36372309 DOI: 10.1016/j.cca.2022.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 10/30/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is a severe complication after cardiac surgery. The early prediction of AKI can facilitate timely intervention and prevent adverse outcomes. We aimed to identify unique serum biomarker that can be used to facilitate early prediction of AKI after cardiac surgery. METHODS A prospective cohort study was performed in cardiac surgery patients, serum samples were collected from 172 patients before surgery, 4 h and 1 day after surgery. We used protein array technology to detect the serum protein expression profile of cardiac surgery-associated AKI (CSA-AKI) patients, and verified the novel biomarker follistatin-like 1 (Fstl1) by expanding the sample size. The primary outcome was AKI, under the definition of Kidney Disease: Improving Global Outcomes (KDIGO). RESULTS Patients with AKI had significantly higher serum Fstl1 levels at 4 h after surgery. After multivariate adjustment, the highest quartile of postoperative serum Fstl1 level, compared with the lowest quartile, associated with 56.3-fold higher odds of AKI. Serum Fstl1 at 4 h post-surgery had a high predictive ability for AKI, severe AKI and major renal adverse events(MAKE) (AUC = 0.713, 0.869 and 0.808, respectively). Adding postoperative 4 h serum Fstl1 to the clinical model can significantly improve the predictive performance of the model. CONCLUSIONS Higher serum Fstl1 levels at 4 h post-surgery is associated with higher odds of AKI after cardiac surgery, and when added to clinical model and Cleveland Score, serum Fstl1 levels at 4 h after cardiac surgery enhanced early prediction of AKI, severe AKI and MAKE in patients undergoing cardiac surgery.
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Affiliation(s)
- Hong Lang
- Department of Nephrology, Sir Run Run Hospital, Nanjing Medical University, 109 Longmian Road, Nanjing, Jiangsu 211166, China
| | - Hang Zhang
- Department of Thoracic Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 650 Xinsongjiang Road, Shanghai 201620, China
| | - Mengqing Ma
- Department of Nephrology, Sir Run Run Hospital, Nanjing Medical University, 109 Longmian Road, Nanjing, Jiangsu 211166, China
| | - Xin Wan
- Department of Nephrology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing, Jiangsu 210006, China
| | - Yuyang Chen
- Department of Nephrology, Sir Run Run Hospital, Nanjing Medical University, 109 Longmian Road, Nanjing, Jiangsu 211166, China
| | - Qing Sun
- Department of Nephrology, Sir Run Run Hospital, Nanjing Medical University, 109 Longmian Road, Nanjing, Jiangsu 211166, China
| | - Changchun Cao
- Department of Nephrology, Sir Run Run Hospital, Nanjing Medical University, 109 Longmian Road, Nanjing, Jiangsu 211166, China.
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Nguyen Duy T, Dao Bui Quy Q, Ho Viet Le D, Le Ha K, Nguyen Huu D, Nguyen Trung K, Tran Van D, Nguyen Oanh O, Luong Cong T, Tran Duc H, Le Viet T. Urinary neutrophil gelatinase-associated lipocalin predicted to contrast-associated acute kidney injury after planned percutaneous coronary intervention in elderly patients. J Clin Lab Anal 2022; 36:e24757. [PMID: 36357318 PMCID: PMC9757015 DOI: 10.1002/jcla.24757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 11/12/2022] Open
Abstract
AIM To determine the proportion of contrast-associated acute kidney injury (CA-AKI) after percutaneous coronary intervention (PCI) and the predictive value of urine neutrophil gelatinase-associated lipocalin (uNGAL) for CA-AKI in elderly patients with chronic coronary artery disease. METHODS A total of 509 patients who had planned percutaneous coronary intervention (mean age was 63.58 ± 11.63 years and 63.3% of males) were divided into two groups: group 1 (n = 153; elderly patients) with ≥70 years old and group 2 (n = 356) with <70 years old. Urine NGAL was measured by the ELISA method. Clinical and laboratory data were collected on the day before intervention. CA-AKI was defined based on Kidney Disease: Improving Global Outcomes criteria. RESULTS The ratio of CA-AKI in group 1 was 23.5% which was higher than that of group 2 (8.7%) with a p-value < 0.001. Urine NGAL level in group 1 was significantly higher than that of group 2 [31.3 (19.16-55.13) ng/ml vs. 19.86 (13.21-29.04) ng/ml, p < 0.001]. At a cut-off value of 44.43 ng/ml, uNGAL had a predictive value for CA-AKI in all patients (AUC = 0.977, p < 0.001). Especially at a cut-off value of 44.14 ng/ml, uNGAL had a predictive value for CA-AKI in elderly patients (AUC = 0.979, p < 0.001). CONCLUSIONS The rate of CA-AKI after PCI in elderly patients was 23.5%. Urine NGAL before PCI had a good predictive value for CA-AKI in elderly patients with chronic coronary artery disease.
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Affiliation(s)
- Toan Nguyen Duy
- Military Hospital 103HanoiVietnam,Vietnam Military Medical UniversityHanoiVietnam
| | | | | | | | | | - Kien Nguyen Trung
- Military Hospital 103HanoiVietnam,Vietnam Military Medical UniversityHanoiVietnam
| | - Duy Tran Van
- Military Hospital 103HanoiVietnam,Vietnam Military Medical UniversityHanoiVietnam
| | - Oanh Nguyen Oanh
- Military Hospital 103HanoiVietnam,Vietnam Military Medical UniversityHanoiVietnam
| | - Thuc Luong Cong
- Military Hospital 103HanoiVietnam,Vietnam Military Medical UniversityHanoiVietnam
| | - Hung Tran Duc
- Military Hospital 103HanoiVietnam,Vietnam Military Medical UniversityHanoiVietnam
| | - Thang Le Viet
- Military Hospital 103HanoiVietnam,Vietnam Military Medical UniversityHanoiVietnam
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Kalisnik JM, Steblovnik K, Hrovat E, Jerin A, Skitek M, Dinges C, Fischlein T, Zibert J. Enhanced Detection of Cardiac Surgery-Associated Acute Kidney Injury by a Composite Biomarker Panel in Patients with Normal Preoperative Kidney Function. J Cardiovasc Dev Dis 2022; 9:jcdd9070210. [PMID: 35877572 PMCID: PMC9317610 DOI: 10.3390/jcdd9070210] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/14/2022] [Accepted: 06/24/2022] [Indexed: 02/01/2023] Open
Abstract
We have recently shown that minor subclinical creatinine dynamic changes enable the excellent detection of acute kidney injury (AKI) within 6–12 h after cardiac surgery. The aim of the present study was to examine a combination of neutrophil gelatinase-associated lipocalin (NGAL), cystatin C (CysC) and creatinine for enhanced AKI detection early after cardiac surgery. Elective patients with normal renal function undergoing cardiac surgery using cardiopulmonary bypass were enrolled. Concentrations of plasma NGAL, serum CysC and serum creatinine were determined after the induction of general anesthesia, at the termination of the cardiopulmonary bypass and 2 h thereafter. Out of 119 enrolled patients, 51 (43%) developed AKI. A model utilizing an NGAL, CysC and creatinine triple biomarker panel including sequential relative changes provides a better prediction of cardiac surgery-associated acute kidney injury than any biomarker alone already 2 h after the termination of the cardiopulmonary bypass. The area under the receiver-operator curve was 0.77, sensitivity 77% and specificity 68%.
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Affiliation(s)
- Jurij Matija Kalisnik
- Department of Cardiac Surgery, Paracelsus Medical University, 40791 Nuremberg, Germany;
- Medical Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia
- Correspondence: ; Tel.: +49-911-398-5441
| | - Klemen Steblovnik
- Department of Cardiology, University Medical Centre, 1000 Ljubljana, Slovenia;
| | - Eva Hrovat
- Department of Cardiovascular Surgery, University Medical Centre, 1000 Ljubljana, Slovenia;
| | - Ales Jerin
- Institute of Clinical Chemistry and Biochemistry, University Medical Centre, 1000 Ljubljana, Slovenia; (A.J.); (M.S.)
- Faculty of Pharmacy, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Milan Skitek
- Institute of Clinical Chemistry and Biochemistry, University Medical Centre, 1000 Ljubljana, Slovenia; (A.J.); (M.S.)
| | - Christian Dinges
- Department of Cardiac, Vascular and Endovascular Surgery, Paracelsus Medical University, 5020 Salzburg, Austria;
| | - Theodor Fischlein
- Department of Cardiac Surgery, Paracelsus Medical University, 40791 Nuremberg, Germany;
| | - Janez Zibert
- Faculty of Health Sciences, University of Ljubljana, 1000 Ljubljana, Slovenia;
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Li T, Yang Y, Huang J, Chen R, Wu Y, Li Z, Lin G, Liu H, Wu M. Machine learning to predict post-operative acute kidney injury stage 3 after heart transplantation. BMC Cardiovasc Disord 2022; 22:288. [PMID: 35752766 PMCID: PMC9233761 DOI: 10.1186/s12872-022-02721-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 06/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) stage 3, one of the most severe complications in patients with heart transplantation (HT), is associated with substantial morbidity and mortality. We aimed to develop a machine learning (ML) model to predict post-transplant AKI stage 3 based on preoperative and perioperative features. METHODS Data from 107 consecutive HT recipients in the provincial center between 2018 and 2020 were included for analysis. Logistic regression with L2 regularization was used for the ML model building. The predictive performance of the ML model was assessed using the area under the curve (AUC) in tenfold stratified cross-validation and was compared with that of the Cleveland-clinical model. RESULTS Post-transplant AKI occurred in 76 (71.0%) patients including 15 (14.0%) stage 1, 18 (16.8%) stage 2, and 43 (40.2%) stage 3 cases. The top six features selected for the ML model to predicate AKI stage 3 were serum cystatin C, estimated glomerular filtration rate (eGFR), right atrial long-axis dimension, left atrial anteroposterior dimension, serum creatinine (SCr) and FVII. The predictive performance of the ML model (AUC: 0.821; 95% confidence interval [CI]: 0.740-0.901) was significantly higher compared with that of the Cleveland-clinical model (AUC: 0.654; 95% [CI]: 0.545-0.763, p < 0.05). CONCLUSIONS The ML model, which achieved an effective predictive performance for post-transplant AKI stage 3, may be helpful for timely intervention to improve the patient's prognosis.
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Affiliation(s)
- Tingyu Li
- Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, China.,Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Yuelong Yang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China.,Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Jinsong Huang
- Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, China
| | - Rui Chen
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Yijin Wu
- Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, China
| | - Zhuo Li
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Guisen Lin
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Hui Liu
- Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China.,Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Min Wu
- Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, China.
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Hukriede NA, Soranno DE, Sander V, Perreau T, Starr MC, Yuen PST, Siskind LJ, Hutchens MP, Davidson AJ, Burmeister DM, Faubel S, de Caestecker MP. Experimental models of acute kidney injury for translational research. Nat Rev Nephrol 2022. [PMID: 35173348 DOI: 10.1038/s41581-022-00539-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2022] [Indexed: 12/20/2022]
Abstract
Preclinical models of human disease provide powerful tools for therapeutic discovery but have limitations. This problem is especially apparent in the field of acute kidney injury (AKI), in which clinical trial failures have been attributed to inaccurate modelling performed largely in rodents. Multidisciplinary efforts such as the Kidney Precision Medicine Project are now starting to identify molecular subtypes of human AKI. In addition, over the past decade, there have been developments in human pluripotent stem cell-derived kidney organoids as well as zebrafish, rodent and large animal models of AKI. These organoid and AKI models are being deployed at different stages of preclinical therapeutic development. However, the traditionally siloed, preclinical investigator-driven approaches that have been used to evaluate AKI therapeutics to date rarely account for the limitations of the model systems used and have given rise to false expectations of clinical efficacy in patients with different AKI pathophysiologies. To address this problem, there is a need to develop more flexible and integrated approaches, involving teams of investigators with expertise in a range of different model systems, working closely with clinical investigators, to develop robust preclinical evidence to support more focused interventions in patients with AKI.
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Karmakova ТА, Sergeeva NS, Kanukoev КY, Alekseev BY, Kaprin АD. Kidney Injury Molecule 1 (KIM-1): a Multifunctional Glycoprotein and Biological Marker (Review). Sovrem Tekhnologii Med 2021; 13:64-78. [PMID: 34603757 PMCID: PMC8482821 DOI: 10.17691/stm2021.13.3.08] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Indexed: 12/17/2022] Open
Abstract
KIM-1 (kidney injury molecule 1) is a transmembrane glycoprotein also known as HAVcr-1 and TIM-1 belongs to the T-cell immunoglobulin and mucin domain family (TIM) of proteins. TIM glycoproteins are presented on the immune cells and participate in the regulation of immune reactions. KIM-1 differs from other members of its family in that it is expressed not only by immunocompetent cells but epithelial cells as well. Cellular and humoral effects mediated by KIM-1 are involved in a variety of physiological and pathophysiological processes. Current understanding of the mechanisms determining the participation of KIM-1 in viral invasion, the immune response regulation, adaptive reactions of the kidney epithelium to acute ischemic or toxic injury, in progression of chronic renal diseases, and kidney cancer development have been presented in this review. Data of clinical researches demonstrating the association of KIM-1 with viral diseases and immune disorders have also been analyzed. Potential application of KIM-1 as urinary or serological marker in renal and cardiovascular diseases has been considered.
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Affiliation(s)
- Т А Karmakova
- Leading Researcher, Department of Predicting the Effectiveness of Conservative Therapy; P. Hertsen Moscow Oncology Research Institute - Branch of the National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, 3, 2 Botkinsky Proezd, Moscow, 125284, Russia
| | - N S Sergeeva
- Professor, Head of the Department of Predicting the Effectiveness of Conservative Therapy; P. Hertsen Moscow Oncology Research Institute - Branch of the National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, 3, 2 Botkinsky Proezd, Moscow, 125284, Russia; Professor, Department of Biology; Pirogov Russian National Research Medical University, 1 Ostrovitianova St., Moscow, 117997, Russia
| | - К Yu Kanukoev
- Urologist, Department of Urology with Chemotherapy; P. Hertsen Moscow Oncology Research Institute - Branch of the National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, 3, 2 Botkinsky Proezd, Moscow, 125284, Russia
| | - B Ya Alekseev
- Professor, Deputy General Director for Science; National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, 4 Koroleva St., Obninsk, 249036, Russia
| | - А D Kaprin
- Professor, Academician of the Russian Academy of Sciences, General Director; National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, 4 Koroleva St., Obninsk, 249036, Russia
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10
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Abstract
Background Recent research shows AKI increases the risk of incident CKD. We hypothesized that perioperative AKI may confer increased risk of subsequent CKD compared to nonperioperative AKI. Methods A MEDLINE search was performed for “AKI, CKD, chronic renal insufficiency, surgery, and perioperative” and related terms yielded 5209 articles. One thousand sixty-five relevant studies were reviewed. One thousand six were excluded because they were review, animal, or pediatric studies. Fifty-nine studies underwent full manuscript review by two independent evaluators. Seventeen met all inclusion criteria and underwent analysis. Two-by-two tables were constructed from AKI +/− and CKD +/− data. The R package metafor was employed to determine odds ratio (OR), and a random-effects model was used to calculate weighted ORs. Leave-1-out, funnel analysis, and structured analysis were used to estimate effects of study heterogeneity and bias. Results Nonperioperative studies included studies of oncology, percutaneous coronary intervention, and myocardial infarction patients. Perioperative studies comprised patients from cardiac surgery, vascular surgery, and burns. There was significant heterogeneity, but risk of bias was overall assessed as low. The OR for AKI versus non-AKI patients developing CKD in all studies was 4.31 (95% CI 3.01–6.17; p < 0.01). Nonperioperative subjects demonstrated OR 3.32 for developing CKD compared to non-AKI patients (95% CI 2.06–5.34; p < 0.01) while perioperative patients demonstrated OR 5.20 (95% CI 3.12–8.66; p < 0.01) for the same event. Conclusions We conclude that studies conducted in perioperative and nonperioperative patient populations suggest similar risk of development of CKD after AKI. Supplementary Information The online version contains supplementary material available at 10.1186/s13741-021-00192-6.
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Affiliation(s)
- Pedro M Abdala
- Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA.
| | - Elizabeth A Swanson
- Medical Scientist Training Program, Oregon Health & Science University, Portland, OR, USA
| | - Michael P Hutchens
- Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA.,Portland Veterans Affairs Medical Center, Operative Care Division, 3710 SW US Veterans Hospital Road, Portland, OR, 97239, USA
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11
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Martin-Lorenzo M, Ramos-Barron A, Gutierrez-Garcia P, Martin-Blazquez A, Santiago-Hernandez A, Rodrigo Calabia E, Gomez-Alamillo C, Alvarez-Llamas G. Urinary Spermidine Predicts and Associates with In-Hospital Acute Kidney Injury after Cardiac Surgery. Antioxidants (Basel) 2021; 10:antiox10060896. [PMID: 34199603 PMCID: PMC8229689 DOI: 10.3390/antiox10060896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 05/27/2021] [Indexed: 01/08/2023] Open
Abstract
Acute Kidney Injury (AKI) affects up to 30% of the patients who undergo cardiac surgery (CVS) and is related to higher mortality. We aim to investigate molecular features associated with in-hospital AKI development and determine the predictive value of these features when analyzed preoperatively. This is a case-control study. From an initial cohort of 110 recruited subjects, a total of 60 patients undergoing cardiac surgery were included: 20 (33%) developed in-hospital AKI (CVS-AKI) and 40 did not (controls, CVS-C). Pre- and post-surgery samples were collected and a prospective study was carried out. A total of 312 serum samples and 258 urine samples were analyzed by nuclear magnetic resonance, mass spectrometry and ELISA. Six features predicted AKI development in pre-surgery samples: urinary kidney functional loss marker kidney injury molecule-1 (uKIM-1), 2-hydroxybutyric acid, 2-hydroxyphenylacetic acid, hippuric acid, phosphoethanolamine and spermidine. Two of them stood out as powerful predictors. Pre-surgery uKIM-1 levels were increased in CVS-AKI vs. CVS-C (AUC = 0.721, p-value = 0.0392) and associated strongly with the outcome (OR = 5.333, p-value = 0.0264). Spermidine showed higher concentration in CVS-AKI (p-value < 0.0001, AUC = 0.970) and had a strong association with the outcome (OR = 69.75, p-value < 0.0001). uKIM-1 and particularly spermidine predict in-hospital AKI associated with CVS in preoperative samples. These findings may aid in preventing postoperative AKI and improve prognosis of CVS.
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Affiliation(s)
- Marta Martin-Lorenzo
- Department of Immunology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz-UAM, 28040 Madrid, Spain; (M.M.-L.); (P.G.-G.); (A.M.-B.); (A.S.-H.)
| | - Angeles Ramos-Barron
- Nephrology Department, Hospital Marqués de Valdecilla, IDIVAL, 39008 Santander, Spain; (A.R.-B.); (E.R.C.); (C.G.-A.)
| | - Paula Gutierrez-Garcia
- Department of Immunology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz-UAM, 28040 Madrid, Spain; (M.M.-L.); (P.G.-G.); (A.M.-B.); (A.S.-H.)
| | - Ariadna Martin-Blazquez
- Department of Immunology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz-UAM, 28040 Madrid, Spain; (M.M.-L.); (P.G.-G.); (A.M.-B.); (A.S.-H.)
| | - Aranzazu Santiago-Hernandez
- Department of Immunology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz-UAM, 28040 Madrid, Spain; (M.M.-L.); (P.G.-G.); (A.M.-B.); (A.S.-H.)
| | - Emilio Rodrigo Calabia
- Nephrology Department, Hospital Marqués de Valdecilla, IDIVAL, 39008 Santander, Spain; (A.R.-B.); (E.R.C.); (C.G.-A.)
- REDInREN, 28040 Madrid, Spain
| | - Carlos Gomez-Alamillo
- Nephrology Department, Hospital Marqués de Valdecilla, IDIVAL, 39008 Santander, Spain; (A.R.-B.); (E.R.C.); (C.G.-A.)
| | - Gloria Alvarez-Llamas
- Department of Immunology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz-UAM, 28040 Madrid, Spain; (M.M.-L.); (P.G.-G.); (A.M.-B.); (A.S.-H.)
- REDInREN, 28040 Madrid, Spain
- Correspondence:
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12
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Liu D, Liu B, Liang Z, Yang Z, Ma F, Yang Y, Hu W. Acute Kidney Injury following Cardiopulmonary Bypass: A Challenging Picture. Oxid Med Cell Longev 2021; 2021:8873581. [PMID: 33763177 DOI: 10.1155/2021/8873581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 02/02/2021] [Accepted: 02/18/2021] [Indexed: 01/10/2023]
Abstract
Recent studies have recognized several risk factors for cardiopulmonary bypass- (CPB-) associated acute kidney injury (AKI). However, the lack of early biomarkers for AKI prevents practitioners from intervening in a timely manner. We reviewed the literature with the aim of improving our understanding of the risk factors for CPB-associated AKI, which may increase our ability to prevent or improve this condition. Some novel early biomarkers for AKI have been introduced. In particular, a combinational use of these biomarkers would be helpful to improve clinical outcomes. Furthermore, we discuss several interventions that are aimed at managing CPB-associated AKI, may increase the effect of renal replacement therapy (RRT), and may contribute to preventing CPB-associated AKI. Collectively, the conclusions of this paper are limited by the availability of clinical trial evidence and conflicting definitions of AKI. A guideline is urgently needed for CPB-associated AKI.
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Ortiz-Soriano V, Kabir S, Claure-Del Granado R, Stromberg A, Toto RD, Moe OW, Goldstein SL, Neyra JA. Assessment of a modified renal angina index for AKI prediction in critically ill adults. Nephrol Dial Transplant 2021; 37:895-903. [PMID: 33605426 DOI: 10.1093/ndt/gfab049] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The renal angina index (RAI) is a useful tool for risk-stratification of acute kidney injury (AKI) in critically ill children. We evaluated the performance of a modified adult RAI (mRAI) for the risk-stratification of AKI in critically ill adults. METHODS We used two independent ICU cohorts: 13,965 adult patients from the University of Kentucky (UKY) and 4,789 from UT Southwestern (UTSW). The mRAI included: diabetes, presence of sepsis, mechanical ventilation, pressor/inotrope use, percentage change in SCr in reference to admission SCr (ΔSCr), and fluid overload percentage within the first day of ICU admission. The primary outcome was AKI stage ≥2 at Day 2-7. Performance and reclassification metrics were determined for the mRAI score compared to ΔSCr alone. RESULTS The mRAI score outperformed ΔSCr and readjusted probabilities to predict AKI stage ≥2 at Day 2-7: C-statistic: UKY 0.781 vs. 0.708 (IDI 2.2%) and UTSW 0.766 vs. 0.696 (IDI 1.8%), p<0.001 for both. In the UKY cohort, only 3.3% of patients with mRAI score <10 had the AKI event, while 16.4% of patients with mRAI score of ≥ 10 had the AKI event (NPV 96.8%). Similar findings were observed in the UTSW cohort as part of external validation. CONCLUSIONS In critically ill adults, the adult mRAI score determined within the first day of ICU admission outperformed changes in SCr for the prediction of AKI stage ≥2 at Day 2-7 of ICU stay. The modified adult RAI is a feasible tool for AKI risk-stratification in adult patients in the ICU.
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Affiliation(s)
- Victor Ortiz-Soriano
- Department of Internal Medicine, Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky Medical Center, Lexington, KY, USA
| | - Shaowli Kabir
- Department of Statistics, University of Kentucky, Lexington, Kentucky, USA
| | | | - Arnold Stromberg
- Department of Statistics, University of Kentucky, Lexington, Kentucky, USA
| | - Robert D Toto
- Department of Internal Medicine, Division of Nephrology, and Charles and Jane Pak Center of Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Orson W Moe
- Department of Internal Medicine, Division of Nephrology, and Charles and Jane Pak Center of Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Stuart L Goldstein
- Center for Acute Care Nephrology, Cincinnati Children's Hospital and Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - Javier A Neyra
- Department of Internal Medicine, Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky Medical Center, Lexington, KY, USA.,Department of Internal Medicine, Division of Nephrology, and Charles and Jane Pak Center of Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Kindgen-Milles D, Dimski T, Brandenburger T. [Acute Kidney Injury: Epidemiology, Pathophysiology, Repair Mechanisms]. Anasthesiol Intensivmed Notfallmed Schmerzther 2021; 56:90-100. [PMID: 33607670 DOI: 10.1055/a-1105-0587] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Acute kidney injury (AKI) is a major complication in critically ill patients and affects up to 50% of those admitted to intensive care units. Causes of AKI include patient specific factors (susceptibility: e.g. age, pre-existing chronic kidney disease, chronic heart failure, diabetes) and patient unspecific factors (exposure: e.g. sepsis, hypovolemia, cardiac surgery, nephrotoxin application). Mortality of severe AKI is in the range of 40 - 50%.AKI is accompanied by volume overload, electrolyte disorders, acidosis, and uremia. The diagnosis of AKI is based on an increase of creatinine levels and/or a decrease in urine output within 7 days after an insult. These 2 markers are late und unspecific, especially with regard to early identification of patients at risk of AKI. New AKI markers have been investigated within the last decade including NGAL (neutrophil gelatinase-associated lipocalin), the product of IGFBP-7 (insulin like growth factor binding protein 7) and TIMP-2 (tissue inhibitor of metalloproteinase 2), KIM-1 (kidney injury molecule 1) and the cysteine-protease-inhibitor cystatin C. New markers or a panel of new markers might improve the diagnosis of patients at risk of AKI in the future.There are currently no specific therapeutics in the treatment of AKI. Therefore, the prevention of AKI is of an utmost importance. The recommended preventive measures include optimization of hemodynamics and volume status, close monitoring of creatinine levels and urine output, avoidance or discontinuation of nephrotoxic drugs, normoglycemia and the application of alternatives to radiocontrast agents if possible.As the long term prognosis of AKI highly depends on renal recovery, the 2 major goals for the future will be 1) the early identification of patients at AKI risk and 2) the support of renal recovery of AKI patients.
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15
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Flannery AH, Bosler K, Ortiz-Soriano VM, Gianella F, Prado V, Lambert J, Toto RD, Moe OW, Neyra JA. Kidney Biomarkers and Major Adverse Kidney Events in Critically Ill Patients. Kidney360 2021; 2:26-32. [PMID: 35368827 PMCID: PMC8785730 DOI: 10.34067/kid.0003552020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 11/02/2020] [Indexed: 02/04/2023]
Abstract
Background Several biomarkers of AKI have been examined for their ability to predict AKI before serum creatinine. Few studies have focused on using kidney biomarkers to better predict major adverse kidney events (MAKE), an increasingly used composite outcome in critical care nephrology research. Methods Single-center prospective study collecting blood and urine samples from critically ill patients with AKI Kidney Disease Improving Global Outcomes stage 2 or above, and matched controls from a single, tertiary care intensive care unit (ICU). Samples were collected at 24-48 hours after AKI diagnosis (patients) or ICU admission (controls), 5-7 days later, and 4-6 weeks after discharge for patients with AKI. The primary outcome of interest was MAKE at hospital discharge (MAKE-DC), consisting of the composite end point of death, RRT dependence, or a decrease in estimated glomerular filtration to <75% of baseline. Results Serum/urinary neutrophil gelatinase-associated lipocalin (NGAL), serum/urinary cystatin C, and urinary kidney injury molecule-1 early in the AKI or ICU course were all significantly higher in patients with MAKE-DC compared with those not experiencing MAKE-DC. Additionally, serum/urinary NGAL and serum cystatin C measurements at the first time point remained significantly associated with MAKE events at 3, 6, and 12 months. Serum cystatin C, and to a lesser extent serum NGAL, significantly improved upon a logistic regression clinical prediction model of MAKE-DC (AUROC 0.94 and 0.87 versus 0.83; P=0.001 and P=0.02, respectively). Patients without MAKE-DC experienced a greater decline in serum NGAL from first to second measurement than those patients experiencing MAKE-DC. Conclusions Early measures of kidney biomarkers in patients who are critically ill are associated with MAKE-DC. This relationship appears to be greatest with serum NGAL and cystatin C, which display additive utility to a clinical prediction model. Trending serum NGAL may also have utility in predicting MAKE-DC.
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Affiliation(s)
- Alexander H. Flannery
- Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, Kentucky
| | - Katherine Bosler
- Department of Otolaryngology–Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
- Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Victor M. Ortiz-Soriano
- Division of Nephrology, Bone and Mineral Metabolism, Department of Internal Medicine, University of Kentucky Medical Center, Lexington, Kentucky
| | - Fabiola Gianella
- Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Victor Prado
- Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Joshua Lambert
- University of Cincinnati College of Nursing, Cincinnati, Ohio
| | - Robert D. Toto
- Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Orson W. Moe
- Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas
- Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Javier A. Neyra
- Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas
- Division of Nephrology, Bone and Mineral Metabolism, Department of Internal Medicine, University of Kentucky Medical Center, Lexington, Kentucky
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16
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Waskowski J, Pfortmueller CA, Schenk N, Buehlmann R, Schmidli J, Erdoes G, Schefold JC. (TIMP2) x (IGFBP7) as early renal biomarker for the prediction of acute kidney injury in aortic surgery (TIGER). A single center observational study. PLoS One 2021; 16:e0244658. [PMID: 33411755 PMCID: PMC7790407 DOI: 10.1371/journal.pone.0244658] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 12/13/2020] [Indexed: 12/13/2022] Open
Abstract
Objective Postoperative acute kidney injury (po-AKI) is frequently observed after major vascular surgery and impacts on mortality rates. Early identification of po-AKI patients using the novel urinary biomarkers insulin-like growth factor-binding-protein 7 (IGFBP7) and tissue inhibitor of metalloproteinases-2 (TIMP-2) might help in early identification of individuals at risk of AKI and enable timely introduction of preventative or therapeutic interventions with the aim of reducing the incidence of po-AKI. We investigated whether biomarker-based monitoring would allow for early detection of po-AKI in patients undergoing abdominal aortic interventions. Methods In an investigator-initiated prospective single-center observational study in a tertiary care academic center, adult patients with emergency/ elective abdominal aortic repair were included. Patients were tested for concentrations of urinary (TIMP-2) x (IGFBP7) at baseline, after surgical interventions (PO), and in the mornings of the first postoperative day (POD1). The primary endpoint was a difference in urinary (TIMP-2) x (IGFBP7) levels at POD1 in patients with/ without po-AKI (all KDIGO stages, po-AKI until seven days after surgery). Secondary endpoints included sensitivity/ specificity analyses of previously proposed cut-off levels and clinical outcome measures (e.g. need for renal replacement therapy). Results 93 patients (n = 71 open surgery) were included. Po-AKI was observed in 33% (31/93) of patients. Urinary (TIMP-2) x (IGFBP7) levels at POD1 did not differ between patients with/ without AKI (median 0.39, interquartile range [IQR] 0.13–1.05 and median 0.23, IQR 0.14–0.53, p = .11, respectively) and PO (median 0.2, IQR 0.08–0.42, 0.18, IQR 0.09–0.46; p = .79). Higher median (TIMP-2) x (IGFBP7) levels were noted in KDIGO stage 3 pAKI patients at POD1 (3.75, IQR 1.97–6.92; p = .003). Previously proposed cutoff levels (0.3, 2) showed moderate sensitivity/ specificity (0.58/0.58 and 0.16/0.98, respectively). Conclusion In a prospective monocentric observational study in patients after abdominal aortic repair, early assessment of urinary (TIMP-2) x (IGFBP7) did not appear to have adequate sensitivity/ specificity to identify patients that later developed postoperative AKI. Clinicaltrials.gov NCT03469765, registered March 19, 2018.
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Affiliation(s)
- Jan Waskowski
- Department of Anesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- * E-mail:
| | - Carmen A. Pfortmueller
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Noelle Schenk
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roman Buehlmann
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Juerg Schmidli
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gabor Erdoes
- Department of Anesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Joerg C. Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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17
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Yamashita K, Abe T, Hayata Y, Hirose T, Hiraga S, Fukuba R, Takemura J, Tonomura R, Yamamoto K, Yokoyama S, Taniguchi S. Copeptin concentration following cardiac surgery as a prognostic marker of postoperative acute kidney injury: a prospective cohort study. J Thorac Dis 2020; 12:6609-6617. [PMID: 33282362 PMCID: PMC7711377 DOI: 10.21037/jtd-20-2323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Copeptin, the C-terminal portion of the arginine vasopressin precursor, is a novel candidate biomarker. This study investigated the prognostic value of copeptin levels following cardiac surgery for the occurrence of postoperative acute kidney injury. Methods We studied 23 patients who underwent cardiac surgery between January 2018 and December 2019. The primary endpoint was postoperative acute kidney injury onset. Copeptin levels were measured before, right after, and daily for 7 days. The patients were divided into two groups according to the copeptin levels: low (values <43.7 pmol/L) and high (values ≥43.7 pmol/L). Correlations between copeptin levels and variables, such as central venous pressure, were assessed by bivariate analysis. Results The high copeptin group exhibited significantly higher levels of arginine vasopressin and cortisol following surgery, compared to those of the low copeptin group. The copeptin concentration following surgery was correlated to central venous pressure (P=0.03) and norepinephrine administered dose (P=0.008). Also, the copeptin levels right after surgery robustly predicted the onset of postoperative acute kidney injury (area under the receiver operating characteristic curve of 0.83, P=0.004). Conclusions Elevated copeptin levels in patients following cardiac surgery predicted postoperative acute kidney injury development. Therefore, the copeptin concentration after surgery could represent a promising clinical biomarker of the postoperative cardiac outcome.
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Affiliation(s)
- Keigo Yamashita
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University School of Medicine, Kashihara City, Nara, Japan
| | - Takehisa Abe
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University School of Medicine, Kashihara City, Nara, Japan
| | - Yoshihiro Hayata
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University School of Medicine, Kashihara City, Nara, Japan
| | - Tomoaki Hirose
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University School of Medicine, Kashihara City, Nara, Japan
| | - Shun Hiraga
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University School of Medicine, Kashihara City, Nara, Japan
| | - Ryohei Fukuba
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University School of Medicine, Kashihara City, Nara, Japan
| | - Junichi Takemura
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University School of Medicine, Kashihara City, Nara, Japan
| | - Rei Tonomura
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University School of Medicine, Kashihara City, Nara, Japan
| | - Kazuki Yamamoto
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University School of Medicine, Kashihara City, Nara, Japan
| | - Shinya Yokoyama
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University School of Medicine, Kashihara City, Nara, Japan
| | - Shigeki Taniguchi
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University School of Medicine, Kashihara City, Nara, Japan
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18
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Koeze J, van der Horst ICC, Keus F, Wiersema R, Dieperink W, Kootstra-Ros JE, Zijlstra JG, van Meurs M. Plasma neutrophil gelatinase-associated lipocalin at intensive care unit admission as a predictor of acute kidney injury progression. Clin Kidney J 2020; 13:994-1002. [PMID: 33391742 PMCID: PMC7769547 DOI: 10.1093/ckj/sfaa002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 12/16/2019] [Indexed: 12/13/2022] Open
Abstract
Background Acute kidney injury (AKI) is a common complication in patients during intensive care unit (ICU) admission. AKI is defined as an increase in serum creatinine (SCr) and/or a reduction in urine output. SCr is a marker of renal function with several limitations, which led to the search for biomarkers for earlier AKI detection. Our aim was to study the predictive value of plasma neutrophil gelatinase-associated lipocalin (NGAL) at admission as a biomarker for AKI progression during the first 48 h of ICU admission in an unselected, heterogeneous ICU patient population. Methods We conducted a prospective observational study in an academic tertiary referral ICU population. We recorded AKI progression in all ICU patients during the first 48 h of ICU admission in a 6-week period. Plasma NGAL was measured at admission but levels were not reported to the attending clinicians. As possible predictors of AKI progression, pre-existing AKI risk factors were recorded. We examined the association of clinical parameters and plasma NGAL levels at ICU admission with the incidence and progression of AKI within the first 48 h of the ICU stay. Results A total of 361 patients were included. Patients without AKI progression during the first 48 h of ICU admission had median NGAL levels at admission of 115 ng/mL [interquartile range (IQR) 81–201]. Patients with AKI progression during the first 48 h of ICU admission had median NGAL levels at admission of 156 ng/mL (IQR 97–267). To predict AKI progression, a multivariant model with age, sex, diabetes mellitus, body mass index, admission type, Acute Physiology and Chronic Health Evaluation score and SCr at admission had an area under the receiver operating characteristics (ROC) curve of 0.765. Adding NGAL to this model showed a small increase in the area under the ROC curve to 0.783 (95% confidence interval 0.714–0.853). Conclusions NGAL levels at admission were higher in patients with progression of AKI during the first 48 h of ICU admission, but adding NGAL levels at admission to a model predicting this AKI progression showed no significant additive value.
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Affiliation(s)
- Jacqueline Koeze
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Iwan C C van der Horst
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Frederik Keus
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Renske Wiersema
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Wim Dieperink
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jenny E Kootstra-Ros
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan G Zijlstra
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Medical Biology Section, Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Matijs van Meurs
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Medical Biology Section, Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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19
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Lanktree MB, Pei Y. Does elevated urinary Dkkopf-3 level predict vulnerability to kidney injury during cardiac surgery? Ann Transl Med 2020; 7:S296. [PMID: 32016015 DOI: 10.21037/atm.2019.11.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Matthew B Lanktree
- Divsion of Nephrology, St. Joseph's Healthcare Hamilton, McMaster University, Hamilton, Ontario, Canada
| | - York Pei
- Divsion of Nephrology, University Health Network and University of Toronto, Toronto, Ontario, Canada
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Thongprayoon C, Lertjitbanjong P, Hansrivijit P, Crisafio A, Mao MA, Watthanasuntorn K, Aeddula NR, Bathini T, Kaewput W, Cheungpasitporn W. Acute Kidney Injury in Patients Undergoing Cardiac Transplantation: A Meta-Analysis. Medicines (Basel) 2019; 6:medicines6040108. [PMID: 31683875 PMCID: PMC6963309 DOI: 10.3390/medicines6040108] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 10/20/2019] [Accepted: 10/29/2019] [Indexed: 05/01/2023]
Abstract
Background: Acute kidney injury (AKI) is a common complication following solid-organ transplantation. However, the epidemiology of AKI and mortality risk of AKI among patients undergoing cardiac transplantation is not uniformly described. We conducted this study to assess the incidence of AKI and mortality risk of AKI in adult patients after cardiac transplantation. Methods: A systematic review of EMBASE, MEDLINE, and Cochrane Databases was performed until June 2019 to identify studies evaluating the incidence of AKI (by standard AKI definitions), AKI requiring renal replacement therapy (RRT), and mortality risk of AKI in patients undergoing cardiac transplantation. Pooled AKI incidence and mortality risk from the included studies were consolidated by random-effects model. The protocol for this study is registered with PROSPERO (no. CRD42019134577). Results: 27 cohort studies with 137,201 patients undergoing cardiac transplantation were identified. Pooled estimated incidence of AKI and AKI requiring RRT was 47.1% (95% CI: 37.6-56.7%) and 11.8% (95% CI: 7.2-18.8%), respectively. The pooled ORs of hospital mortality and/or 90-day mortality among patients undergoing cardiac transplantation with AKI and AKI requiring RRT were 3.46 (95% CI, 2.40-4.97) and 13.05 (95% CI, 6.89-24.70), respectively. The pooled ORs of 1-year mortality among patients with AKI and AKI requiring RRT were 2.26 (95% CI, 1.56-3.26) and 3.89 (95% CI, 2.49-6.08), respectively. Conclusion: Among patients undergoing cardiac transplantation, the incidence of AKI and severe AKI requiring RRT are 47.1% and 11.8%, respectively. AKI post cardiac transplantation is associated with reduced short term and 1-year patient survival.
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Affiliation(s)
- Charat Thongprayoon
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MM 55905, USA.
| | | | - Panupong Hansrivijit
- Department of Internal Medicine, University of Pittsburgh Medical Center Pinnacle, Harrisburg, PA 17105, USA.
| | - Anthony Crisafio
- St George's University, School of Medicine University Centre Grenada, West Indies, St George, Grenada.
| | - Michael A Mao
- Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL 32224, USA.
| | | | | | - Tarun Bathini
- Department of Internal Medicine, University of Arizona, Tucson, AZ 85721, USA.
| | - Wisit Kaewput
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok 10400, Thailand.
| | - Wisit Cheungpasitporn
- Division of Nephrology, University of Mississippi Medical Center, Jackson, MS 39216, USA.
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