Abstract
ObjectivePostoperative acute kidney injury (po-AKI) is frequently observed after major vascular surgery and impacts on mortality rates. Early identification of po-AKI patients using the novel urinary biomarkers insulin-like growth factor-binding-protein 7 (IGFBP7) and tissue inhibitor of metalloproteinases-2 (TIMP-2) might help in early identification of individuals at risk of AKI and enable timely introduction of preventative or therapeutic interventions with the aim of reducing the incidence of po-AKI. We investigated whether biomarker-based monitoring would allow for early detection of po-AKI in patients undergoing abdominal aortic interventions.MethodsIn an investigator-initiated prospective single-center observational study in a tertiary care academic center, adult patients with emergency/ elective abdominal aortic repair were included. Patients were tested for concentrations of urinary (TIMP-2) x (IGFBP7) at baseline, after surgical interventions (PO), and in the mornings of the first postoperative day (POD1). The primary endpoint was a difference in urinary (TIMP-2) x (IGFBP7) levels at POD1 in patients with/ without po-AKI (all KDIGO stages, po-AKI until seven days after surgery). Secondary endpoints included sensitivity/ specificity analyses of previously proposed cut-off levels and clinical outcome measures (e.g. need for renal replacement therapy).Results93 patients (n = 71 open surgery) were included. Po-AKI was observed in 33% (31/93) of patients. Urinary (TIMP-2) x (IGFBP7) levels at POD1 did not differ between patients with/ without AKI (median 0.39, interquartile range [IQR] 0.13–1.05 and median 0.23, IQR 0.14–0.53, p = .11, respectively) and PO (median 0.2, IQR 0.08–0.42, 0.18, IQR 0.09–0.46; p = .79). Higher median (TIMP-2) x (IGFBP7) levels were noted in KDIGO stage 3 pAKI patients at POD1 (3.75, IQR 1.97–6.92; p = .003). Previously proposed cutoff levels (0.3, 2) showed moderate sensitivity/ specificity (0.58/0.58 and 0.16/0.98, respectively).ConclusionIn a prospective monocentric observational study in patients after abdominal aortic repair, early assessment of urinary (TIMP-2) x (IGFBP7) did not appear to have adequate sensitivity/ specificity to identify patients that later developed postoperative AKI.Clinicaltrials.govNCT03469765, registered March 19, 2018.
Highlights
Post-operative acute kidney injury is often observed after cardiovascular surgery and negatively impacts on both morbidity and mortality rates [1]
The primary endpoint was a difference in urinary (TIMP-2) x (IGFBP7) levels at POD1 in patients with/ without Post-operative acute kidney injury (po-AKI)
Po-AKI was observed in 33% (31/93) of patients
Summary
Post-operative acute kidney injury (po-AKI) is often observed after cardiovascular surgery and negatively impacts on both morbidity and mortality rates [1]. AKI incidence in open abdominal aortic repair is reported to range from 20–37% [2], and increases to about 68% and 75% in suprarenal aortic aneurysm repair and ruptured aortic aneurysms, respectively [3]. In endovascular aortic repair (EVAR), AKI is noted in 9–18% of cases [3,4]. Post-operative renal (dys)-function is influenced by several factors including pre-operative renal function, co-morbidities, intraoperative factors (e.g. aortic clamping site and time, ischemia-reperfusion injury), hemodynamic instability (including vasopressor use, blood loss and need for volume replacement) and post-operative complications [5,6,7,8]. Respective indices may be considered insensitive in regard to timely po-AKI recognition [12]
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