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Kidney Tubular Damage and Functional Biomarkers in Acute Kidney Injury Following Cardiac Surgery

BACKGROUND: Cardiac surgery–associated acute kidney injury (AKI) is associated with increased morbidity and mortality. We examined the utility of combining biomarkers of kidney function loss (serum cystatin C) and kidney tubular damage (urine neutrophil gelatinase-associated lipocalin [NGAL] and Kid...

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Autores principales: Neyra, Javier A., Hu, Ming-Chang, Minhajuddin, Abu, Nelson, Geoffrey E., Ahsan, Syed A., Toto, Robert D., Jessen, Michael E., Moe, Orson W., Fox, Amanda A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6698294/
https://www.ncbi.nlm.nih.gov/pubmed/31440703
http://dx.doi.org/10.1016/j.ekir.2019.05.005
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author Neyra, Javier A.
Hu, Ming-Chang
Minhajuddin, Abu
Nelson, Geoffrey E.
Ahsan, Syed A.
Toto, Robert D.
Jessen, Michael E.
Moe, Orson W.
Fox, Amanda A.
author_facet Neyra, Javier A.
Hu, Ming-Chang
Minhajuddin, Abu
Nelson, Geoffrey E.
Ahsan, Syed A.
Toto, Robert D.
Jessen, Michael E.
Moe, Orson W.
Fox, Amanda A.
author_sort Neyra, Javier A.
collection PubMed
description BACKGROUND: Cardiac surgery–associated acute kidney injury (AKI) is associated with increased morbidity and mortality. We examined the utility of combining biomarkers of kidney function loss (serum cystatin C) and kidney tubular damage (urine neutrophil gelatinase-associated lipocalin [NGAL] and Kidney Injury Molecule-1 [KIM-1]) for the prediction of post–cardiac surgery AKI. METHODS: Single-center prospective cohort study of 106 adults undergoing coronary artery bypass grafting and/or valve surgery with cardiopulmonary bypass (CPB). Primary outcome was postoperative in-hospital AKI defined by serum creatinine (SCr)–Kidney Disease: Improving Global Outcomes criteria. Biomarkers were measured preoperatively, 6 hours after CPB and on postoperative days (PODs) 1 to 4. RESULTS: A total of 23 subjects (21.7%) developed AKI. After adjusting for preoperative left ventricular ejection fraction, body mass index >30 kg/m(2), and estimated glomerular filtration rate (eGFR) <60 ml/min per 1.73 m(2), the combination of peak serum cystatin C and peak urine KIM-1/creatinine (Cr) (6 hours post-CPB to POD 1) above optimal cutoff significantly associated with postoperative AKI (odds ratio [OR]: 5.32; 95% confidence interval [CI]: 1.31–21.67; P = 0.020). This biomarker combination significantly improved the performance of the clinical model for the prediction of postoperative AKI (area under the curve [AUC]: 0.77, 95% CI: 0.65–0.90 for the clinical model alone versus 0.83, 95% CI: 0.73–0.93 for the clinical model with the addition of biomarker data, P = 0.049). CONCLUSIONS: Combining biomarkers of postoperative kidney function loss and postoperative kidney tubular damage significantly improved prediction of in-hospital AKI following cardiac surgery. Future large, multicenter studies are warranted to assess whether panels of biomarkers reflecting distinct pathobiology can be used to guide interventions and improve short- and long-term outcomes in patients undergoing cardiac surgery.
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spelling pubmed-66982942019-08-22 Kidney Tubular Damage and Functional Biomarkers in Acute Kidney Injury Following Cardiac Surgery Neyra, Javier A. Hu, Ming-Chang Minhajuddin, Abu Nelson, Geoffrey E. Ahsan, Syed A. Toto, Robert D. Jessen, Michael E. Moe, Orson W. Fox, Amanda A. Kidney Int Rep Clinical Research BACKGROUND: Cardiac surgery–associated acute kidney injury (AKI) is associated with increased morbidity and mortality. We examined the utility of combining biomarkers of kidney function loss (serum cystatin C) and kidney tubular damage (urine neutrophil gelatinase-associated lipocalin [NGAL] and Kidney Injury Molecule-1 [KIM-1]) for the prediction of post–cardiac surgery AKI. METHODS: Single-center prospective cohort study of 106 adults undergoing coronary artery bypass grafting and/or valve surgery with cardiopulmonary bypass (CPB). Primary outcome was postoperative in-hospital AKI defined by serum creatinine (SCr)–Kidney Disease: Improving Global Outcomes criteria. Biomarkers were measured preoperatively, 6 hours after CPB and on postoperative days (PODs) 1 to 4. RESULTS: A total of 23 subjects (21.7%) developed AKI. After adjusting for preoperative left ventricular ejection fraction, body mass index >30 kg/m(2), and estimated glomerular filtration rate (eGFR) <60 ml/min per 1.73 m(2), the combination of peak serum cystatin C and peak urine KIM-1/creatinine (Cr) (6 hours post-CPB to POD 1) above optimal cutoff significantly associated with postoperative AKI (odds ratio [OR]: 5.32; 95% confidence interval [CI]: 1.31–21.67; P = 0.020). This biomarker combination significantly improved the performance of the clinical model for the prediction of postoperative AKI (area under the curve [AUC]: 0.77, 95% CI: 0.65–0.90 for the clinical model alone versus 0.83, 95% CI: 0.73–0.93 for the clinical model with the addition of biomarker data, P = 0.049). CONCLUSIONS: Combining biomarkers of postoperative kidney function loss and postoperative kidney tubular damage significantly improved prediction of in-hospital AKI following cardiac surgery. Future large, multicenter studies are warranted to assess whether panels of biomarkers reflecting distinct pathobiology can be used to guide interventions and improve short- and long-term outcomes in patients undergoing cardiac surgery. Elsevier 2019-05-18 /pmc/articles/PMC6698294/ /pubmed/31440703 http://dx.doi.org/10.1016/j.ekir.2019.05.005 Text en © 2019 International Society of Nephrology. Published by Elsevier Inc. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Clinical Research
Neyra, Javier A.
Hu, Ming-Chang
Minhajuddin, Abu
Nelson, Geoffrey E.
Ahsan, Syed A.
Toto, Robert D.
Jessen, Michael E.
Moe, Orson W.
Fox, Amanda A.
Kidney Tubular Damage and Functional Biomarkers in Acute Kidney Injury Following Cardiac Surgery
title Kidney Tubular Damage and Functional Biomarkers in Acute Kidney Injury Following Cardiac Surgery
title_full Kidney Tubular Damage and Functional Biomarkers in Acute Kidney Injury Following Cardiac Surgery
title_fullStr Kidney Tubular Damage and Functional Biomarkers in Acute Kidney Injury Following Cardiac Surgery
title_full_unstemmed Kidney Tubular Damage and Functional Biomarkers in Acute Kidney Injury Following Cardiac Surgery
title_short Kidney Tubular Damage and Functional Biomarkers in Acute Kidney Injury Following Cardiac Surgery
title_sort kidney tubular damage and functional biomarkers in acute kidney injury following cardiac surgery
topic Clinical Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6698294/
https://www.ncbi.nlm.nih.gov/pubmed/31440703
http://dx.doi.org/10.1016/j.ekir.2019.05.005
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