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Outcome Prediction of Acute Kidney Injury Biomarkers at Initiation of Dialysis in Critical Units

The ideal circumstances for whether and when to start RRT remain unclear. The outcome predictive ability of acute kidney injury (AKI) biomarkers measuring at dialysis initializing need more validation. This prospective, multi-center observational cohort study enrolled 257 patients with AKI undergoin...

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Autores principales: Wu, Vin-Cent, Shiao, Chih-Chung, Chi, Nai-Hsin, Wang, Chih-Hsien, Chueh, Shih-Chieh Jeff, Liou, Hung-Hsiang, Spapen, Herbert D., Honore, Patrick M., Chu, Tzong-Shinn
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6112021/
https://www.ncbi.nlm.nih.gov/pubmed/30082648
http://dx.doi.org/10.3390/jcm7080202
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author Wu, Vin-Cent
Shiao, Chih-Chung
Chi, Nai-Hsin
Wang, Chih-Hsien
Chueh, Shih-Chieh Jeff
Liou, Hung-Hsiang
Spapen, Herbert D.
Honore, Patrick M.
Chu, Tzong-Shinn
author_facet Wu, Vin-Cent
Shiao, Chih-Chung
Chi, Nai-Hsin
Wang, Chih-Hsien
Chueh, Shih-Chieh Jeff
Liou, Hung-Hsiang
Spapen, Herbert D.
Honore, Patrick M.
Chu, Tzong-Shinn
author_sort Wu, Vin-Cent
collection PubMed
description The ideal circumstances for whether and when to start RRT remain unclear. The outcome predictive ability of acute kidney injury (AKI) biomarkers measuring at dialysis initializing need more validation. This prospective, multi-center observational cohort study enrolled 257 patients with AKI undergoing renal replacement therapy (RRT) shortly after admission. At the start of RRT, blood and urine samples were collected for relevant biomarker measurement. RRT dependence and all-cause mortality were recorded up to 90 days after discharge. Areas under the receiver operator characteristic (AUROC) curves and a multivariate generalized additive model were applied to predict outcomes. One hundred and thirty-five (52.5%) patients died within 90 days of hospital discharge. Plasma c-terminal FGF-23 (cFGF-23) had the best discriminative ability (AUROC, 0.687) as compared with intact FGF-23 (iFGF-23) (AUROC, 0.504), creatinine-adjusted urine neutrophil gelatinase-associated lipocalin (AUROC, 0.599), and adjusted urine cFGF-23 (AUROC, 0.653) regardless whether patients were alive or not on day 90. Plasma cFGF-23 levels above 2050 RU/mL were independently associated with higher 90-day mortality (HR 1.76, p = 0.020). Higher cFGF-23 levels predicted less weaning from dialysis in survivors (HR, 0.62, p = 0.032), taking mortality as a competing risk. Adding cFGF-23 measurement to the AKI risk predicting score significantly improved risk stratification and 90-day mortality prediction (total net reclassification improvement = 0.148; p = 0.002). In patients with AKI who required RRT, increased plasma cFGF-23 levels correlated with higher 90-day overall mortality after discharge and predicted worse kidney recovery in survivors. When coupled to the AKI risk predicting score, cFGF-23 significantly improved mortality risk prediction. This observation adds evidence that cFGF-23 could be used as an optimal timing biomarker to initiate RRT.
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spelling pubmed-61120212018-08-28 Outcome Prediction of Acute Kidney Injury Biomarkers at Initiation of Dialysis in Critical Units Wu, Vin-Cent Shiao, Chih-Chung Chi, Nai-Hsin Wang, Chih-Hsien Chueh, Shih-Chieh Jeff Liou, Hung-Hsiang Spapen, Herbert D. Honore, Patrick M. Chu, Tzong-Shinn J Clin Med Article The ideal circumstances for whether and when to start RRT remain unclear. The outcome predictive ability of acute kidney injury (AKI) biomarkers measuring at dialysis initializing need more validation. This prospective, multi-center observational cohort study enrolled 257 patients with AKI undergoing renal replacement therapy (RRT) shortly after admission. At the start of RRT, blood and urine samples were collected for relevant biomarker measurement. RRT dependence and all-cause mortality were recorded up to 90 days after discharge. Areas under the receiver operator characteristic (AUROC) curves and a multivariate generalized additive model were applied to predict outcomes. One hundred and thirty-five (52.5%) patients died within 90 days of hospital discharge. Plasma c-terminal FGF-23 (cFGF-23) had the best discriminative ability (AUROC, 0.687) as compared with intact FGF-23 (iFGF-23) (AUROC, 0.504), creatinine-adjusted urine neutrophil gelatinase-associated lipocalin (AUROC, 0.599), and adjusted urine cFGF-23 (AUROC, 0.653) regardless whether patients were alive or not on day 90. Plasma cFGF-23 levels above 2050 RU/mL were independently associated with higher 90-day mortality (HR 1.76, p = 0.020). Higher cFGF-23 levels predicted less weaning from dialysis in survivors (HR, 0.62, p = 0.032), taking mortality as a competing risk. Adding cFGF-23 measurement to the AKI risk predicting score significantly improved risk stratification and 90-day mortality prediction (total net reclassification improvement = 0.148; p = 0.002). In patients with AKI who required RRT, increased plasma cFGF-23 levels correlated with higher 90-day overall mortality after discharge and predicted worse kidney recovery in survivors. When coupled to the AKI risk predicting score, cFGF-23 significantly improved mortality risk prediction. This observation adds evidence that cFGF-23 could be used as an optimal timing biomarker to initiate RRT. MDPI 2018-08-06 /pmc/articles/PMC6112021/ /pubmed/30082648 http://dx.doi.org/10.3390/jcm7080202 Text en © 2018 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Wu, Vin-Cent
Shiao, Chih-Chung
Chi, Nai-Hsin
Wang, Chih-Hsien
Chueh, Shih-Chieh Jeff
Liou, Hung-Hsiang
Spapen, Herbert D.
Honore, Patrick M.
Chu, Tzong-Shinn
Outcome Prediction of Acute Kidney Injury Biomarkers at Initiation of Dialysis in Critical Units
title Outcome Prediction of Acute Kidney Injury Biomarkers at Initiation of Dialysis in Critical Units
title_full Outcome Prediction of Acute Kidney Injury Biomarkers at Initiation of Dialysis in Critical Units
title_fullStr Outcome Prediction of Acute Kidney Injury Biomarkers at Initiation of Dialysis in Critical Units
title_full_unstemmed Outcome Prediction of Acute Kidney Injury Biomarkers at Initiation of Dialysis in Critical Units
title_short Outcome Prediction of Acute Kidney Injury Biomarkers at Initiation of Dialysis in Critical Units
title_sort outcome prediction of acute kidney injury biomarkers at initiation of dialysis in critical units
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6112021/
https://www.ncbi.nlm.nih.gov/pubmed/30082648
http://dx.doi.org/10.3390/jcm7080202
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