Abstract
BackgroundAcute kidney injury (AKI) after cardiovascular surgery is a serious complication. Little is known about the ability of novel biomarkers in combination with clinical risk scores for prediction of advanced AKI.MethodsIn this prospectively conducted multicenter study, urine samples were collected from 149 adults at 0, 3, 6, 12 and 24 h after cardiovascular surgery. We measured urinary hemojuvelin (uHJV), kidney injury molecule-1 (uKIM-1), neutrophil gelatinase-associated lipocalin (uNGAL), α-glutathione S-transferase (uα-GST) and π-glutathione S-transferase (uπ-GST). The primary outcome was advanced AKI, under the definition of Kidney Disease: Improving Global Outcomes (KDIGO) stage 2, 3 and composite outcomes were KDIGO stage 2, 3 or 90-day mortality after hospital discharge.ResultsPatients with advanced AKI had significantly higher levels of uHJV and uKIM-1 at 3, 6 and 12 h after surgery. When normalized by urinary creatinine level, uKIM-1 in combination with uHJV at 3 h post-surgery had a high predictive ability for advanced AKI and composite outcome (AUC = 0.898 and 0.905, respectively). The combination of this biomarker panel (normalized uKIM-1, uHJV at 3 h post-operation) and Liano’s score was superior in predicting advanced AKI (AUC = 0.931, category-free net reclassification improvement of 1.149, and p < 0.001).ConclusionsWhen added to Liano’s score, normalized uHJV and uKIM-1 levels at 3 h after cardiovascular surgery enhanced the identification of patients at higher risk of progression to advanced AKI and composite outcomes.
Highlights
Acute kidney injury (AKI) after cardiovascular surgery is a serious complication
Patients with the following conditions were excluded: those who were younger than 18 years of age, those who were diagnosed with acute kidney injury (AKI) under the Kidney Disease: Improving Global Outcomes (KDIGO) definitions during index hospitalization before surgery, those who had undergone renal replacement therapy, those who had a history of nephrectomy or renal transplantation and estimated glomerular filtration rate < 30 mL/1.73 m2 at the time of Intensive care unit (ICU) enrollment
There were no statistical differences between patients with and without advanced AKI with respect to age, gender, body mass index (BMI), comorbidities, baseline kidney function, baseline chronic kidney disease
Summary
Acute kidney injury (AKI) after cardiovascular surgery is a serious complication. Little is known about the ability of novel biomarkers in combination with clinical risk scores for prediction of advanced AKI. Novel biomarkers can detect renal tubular injury earlier than serum creatinine in the setting of AKI [6,7,8] As these markers correlate with renal tubular injury or function, their concentrations in urine over time, alone or in combination, could provide important information on the progression of AKI [9]. Most of those patients who develop AKI experience a milder form of AKI (e.g., Kidney Disease: Improving Global Outcomes (KDIGO) stage 1) with transient shifts in serum creatinine, and do not progress to more advanced stages of AKI (KDIGO stage 2 or 3) or require acute dialysis [10,11,12]. Whereas previous studies have attempted to predict AKI (defined as worsening of KDIGO stage) rather than
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