Acute kidney disease and acute kidney injury biomarkers in coronary care unit patients

Yih-Ting Chen,Cheng-Kai Hsu,Yung-Chang Chen,Yi-Ching Yu,Heng-Chih Pan,Wen-Jin Cherng,Pei-Chun Fan,Chih-Hsiang Chang,I-Wen Wu,Chang-Chyi Jenq

doi:10.1186/s12882-020-01872-z

Abstract

BackgroundAcute kidney disease (AKD) describes acute or subacute damage and/or loss of kidney function for a duration of between 7 and 90 days after exposure to an acute kidney injury (AKI) initiating event. This study investigated the predictive ability of AKI biomarkers in predicting AKD in coronary care unit (CCU) patients.MethodsA total of 269 (mean age: 64 years; 202 (75%) men and 67 (25%) women) patients admitted to the CCU of a tertiary care teaching hospital from November 2009 to September 2014 were enrolled. Information considered necessary to evaluate 31 demographic, clinical and laboratory variables (including AKI biomarkers) was prospectively recorded on the first day of CCU admission for post hoc analysis as predictors of AKD. Blood and urinary samples of the enrolled patients were tested for neutrophil gelatinase-associated lipocalin (NGAL), cystatin C (CysC) and interleukin-18 (IL-18).ResultsThe overall hospital mortality rate was 4.8%. Of the 269 patients, 128 (47.6%) had AKD. Multivariate logistic regression analysis revealed that age, hemoglobin, ejection fraction and serum IL-18 were independent predictors of AKD. Cumulative survival rates at 5 years of follow-up after hospital discharge differed significantly (p < 0.001) between subgroups of patients diagnosed with AKD (stage 0A, 0C, 1, 2 and 3). The overall 5-year survival rate was 81.8% (220/269). Multivariate Cox proportional hazard analysis revealed that urine NGAL, body weight and hemoglobin level were independent risk factors for 5-year mortality.ConclusionsThis investigation confirmed that AKI biomarkers can predict AKD in CCU patients. Age, hemoglobin, ejection fraction and serum IL-18 were independently associated with developing AKD in the CCU patients, and urine NGAL, body weight and hemoglobin level could predict 5-year survival in these patients.

Highlights

Acute kidney disease (AKD) describes acute or subacute damage and/or loss of kidney function for a duration of between 7 and 90 days after exposure to an acute kidney injury (AKI) initiating event
Previous studies have reported that AKI biomarkers including cystatin C (CysC), IL-18 and neutrophil gelatinase-associated lipocalin (NGAL) can improve the diagnosis of intrinsic AKI in coronary care unit (CCU) patients [9, 10]
We demonstrated that body weight and hemoglobin and urine NGAL levels were independently associated with the risk of all-cause 5-year mortality in our CCU patients, which is consistent with previously published studies

Summary

Introduction

Acute kidney disease (AKD) describes acute or subacute damage and/or loss of kidney function for a duration of between 7 and 90 days after exposure to an acute kidney injury (AKI) initiating event. This study investigated the predictive ability of AKI biomarkers in predicting AKD in coronary care unit (CCU) patients. Kidney damage lasting between 7 and 90 days after an acute kidney injury (AKI) is termed acute kidney disease (AKD) [1,2,3]. Many studies have reported on AKI and chronic kidney disease (CKD), few studies have investigated AKD. The causes of renal function impairment in patients admitted to a coronary care unit (CCU) are complex and multifactorial [4,5,6,7]. The role of AKI biomarkers in the diagnosis of AKD and the impact of AKD on mortality are unclear, and new classification systems for AKD may improve standardization of the diagnosis and staging of this clinical syndrome

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