#3759 URINARY DCR2/CR LEVEL PREDICTS RENAL OUTCOME IN PATIENTS WITH ACUTE KIDNEY INJURY

Abstract

Abstract Background and Aims Acute kidney injury (AKI) is a well-recognized complication of critical illness which increases the risk of morbidity and mortality. It has been reported that about 30% of AKI patients developed to chronic kidney disease (CKD), and even to end-stage renal disease (ESRD). It is urgent to explore novel biomarkers to evaluation the renal outcome of AKI. Decoy receptor 2 (DcR2), a senescent marker, is expressed specifically in senescent tubular epithelia. And urinary DcR2 (uDcR2) is associated with renal fibrosis in chronic kidney disease. The aim of study is to investigate the association of urine DcR2 with renal outcome of AKI. Method 153 biopsy-proven AKI patients were included from Daping Hospital, Army Medical University from January 2018 to October 2022. A composite renal endpoint included creatinine more than 50% higher than the baseline or ESRD after 90 days. All patients were divided into positive endpoints (n = 75) and negative endpoints (n = 78). The clinical characteristics were collected, and the pathological injury was scored. uDcR2 levels were measured using enzyme-linked immunosorbent assay and normalized to urinary cre (uDcR2/Cr). The correlation of uDcR2/Cr levels with renal function and renal pathological scores were analyzed. The logistic regression analysis was used to investigate the association of uDcR2/Cr with endpoint positive, after adjustment for probable causes of both exposure and outcome. The association of uDcR2/Cr with the composite renal endpoint using Kaplan-Meier curves were calculated. Results The level of uDcR2/Cr was positively correlated with cystatin C, and negatively correlated with estimated glomerular filtration rate (eGFR). And uDcR2/Cr was positively associated with renal pathological acute scores. Univariate logistic regression results increase the risk factors for poor kidney prognosis are age, female, with hypertension or (and) CKD, eGFR, Cystine C and uDcR2/Cr. Multivariate logistic regression analysis showed that the effect of uDcR2/Cr on renal outcome was statistically significant. After a median follow-up of 16 months, 75 participants achieve endpoint and there were 16 patients with end-stage renal disease. The ROC curve was used to analyze the value of uDcR2/Cr for predicting kidney prognosis in AKI with an area under the curve of 0.72 and the cut-off value of 365ng/g Cr. The median time from at the time of AKI to endpoint in the uDcR2/Cr≥365ng/g Cr group (7.6 months) was significantly shorter compared to the uDcR2/Cr<365ng/g Cr group (36.6 months). Conclusion Urinary DcR2/Cr is closely associated to kidney injury and renal prognosis of AKI, suggesting that uDcR2/Cr could sever as a novel biomarker for predicting adverse outcomes in patients with AKI.