Abstract

BackgroundDickkopf-3 (DKK3) has recently been discovered as a urinary biomarker for the prediction of acute kidney injury (AKI) after cardiac surgery. This finding needs to be confirmed for AKI in other clinical settings. The present study investigates whether DKK3 can predict contrast-induced AKI (CI-AKI).MethodsWe performed a prospective study in 490 patients undergoing coronary angiography. Primary endpoint was an increase in serum creatinine concentration ≥ 0.3 mg/dl within 72 h after the procedure. DKK3 was assessed < 24 h before coronary angiography. Predictive accuracy was assessed by receiver operating characteristic (ROC) curves.ResultsCI-AKI was observed in 30 (6.1%) patients, of whom 27 corresponded to stage I and 3 to stage II according to the Acute Kidney Injury Network (AKIN) criteria. Subjects who developed CI-AKI had a 3.8-fold higher urinary DKK3/creatinine ratio than those without CI-AKI (7.5 pg/mg [interquartile range [IQR] 1.2–1392.0] vs. 2.0 pg/mg [IQR 0.9–174.0]; p = 0.047). ROC analysis revealed an area under the curve (AUC) of 0.61. Among subjects without clinically overt chronic kidney disease (estimated glomerular filtration rate [eGFR] > 60 ml/min, urinary albumin creatinine ratio < 30 mg/g), the DKK3/creatinine ratio was 5.4-fold higher in those with subsequent CI-AKI (7.5 pg/mg [IQR 0.9–590.1] vs. 1.38 pg/mg [IQR 0.8–51.0]; p = 0.007; AUC 0.62). Coronary angiography was associated with a 43 times increase in the urinary DKK3/creatinine ratio.ConclusionsUrinary DKK3 is an independent predictor of CI-AKI even in the absence of overt chronic kidney disease (CKD). The study thereby expands the findings on DKK3 in the prediction of postoperative loss of kidney function to other entities of AKI.Graphic abstract

Highlights

  • Dickkopf-3 (DKK3) is a recently discovered stress-induced tubular-derived renal biomarker for interstitial fibrosis [1]

  • The present prospective study investigates the association of pre-procedural urinary DKK3 concentrations with subsequent CI-acute kidney injury (AKI) in subjects undergoing coronary angiography

  • A second sample of urine and blood was obtained 48 to 72 h after contrast media. Both urine samples were analyzed for DKK3, albumin and creatinine concentrations. estimated GFR (eGFR) was calculated by means of the MDRD formula and AKI was defined according to Acute Kidney Injury Network (AKIN) criteria [5]

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Summary

Introduction

Dickkopf-3 (DKK3) is a recently discovered stress-induced tubular-derived renal biomarker for interstitial fibrosis [1]. The present prospective study investigates the association of pre-procedural urinary DKK3 concentrations with subsequent CI-AKI in subjects undergoing coronary angiography. It is thereby the first validation study of the above mentioned proof of principle study and examines the potential prediction of AKI by DKK3 in the setting of cardiac catheterization, one of the most frequently performed clinical procedures. Dickkopf-3 (DKK3) has recently been discovered as a urinary biomarker for the prediction of acute kidney injury (AKI) after cardiac surgery. This finding needs to be confirmed for AKI in other clinical settings. The study thereby expands the findings on DKK3 in the prediction of postoperative loss of kidney function to other entities of AKI

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