Predictive Value of Urinary Aquaporin 2 for Acute Kidney Injury in Patients with Acute Decompensated Heart Failure.

Ming-Jen Chan,George Kou,Yung-Chang Chen,Pei-Chun Fan,Cheng-Chia Lee,Chih-Hsiang Chang

doi:10.3390/biomedicines10030613

Abstract

Acute kidney injury (AKI) is frequently encountered in people with acute decompensated heart failure (ADHF) and is associated with increased morbidity and mortality. Early detection of a urinary biomarker of kidney injury might allow a prompt diagnosis and improve outcomes. Levels of urinary aquaporin 2 (UAQP2), which is also associated with several renal diseases, are increased with ADHF. We aimed to determine whether UAQP2 predicted AKI in patients with ADHF. We conducted a prospective observation study in the coronary care unit (CCU) in a tertiary care university hospital in Taiwan. Individuals with ADHF admitted to the CCU between November 2009 and November 2014 were enrolled, and serum and urinary samples were collected. AKI was diagnosed in 69 (36.5%) of 189 adult patients (mean age: 68 years). Area under the receiver operating characteristic curve (AUROC) of biomarkers was evaluated to evaluate the diagnostic power for AKI. Both brain natriuretic peptide and UAQP2 demonstrated acceptable AUROCs (0.759 and 0.795, respectively). A combination of the markers had an AUROC of 0.802. UAQP2 is a potential biomarker of AKI in CCU patients with ADHF. Additional research on this novel biomarker is required.

Highlights

To compensate for variation in urine dilution, urine urinary aquaporin 2 (UAQP2) values were adjusted according to urine creatinine (UCr)
The median UAQP2/Cr levels in the Acute kidney injury (AKI) and non-AKI groups were 1.09 fmol/mg and 0.35 fmol/mg, respectively (p < 0.001; Table 1). Levels of both serum brain natriuretic peptide (BNP) and UAQP2 increased with AKI severity (Figure 1)
The Area under the receiver operating characteristic curve (AUROC) of serum BNP, UQAP2, and normalized UAQP2 were 75.9% (95% confidence interval (CI) 69.0–82.9), 79.5%, and 76.1%, respectively, with acceptable performance (Figure 2a)