Utility of suPAR and NGAL for AKI Risk Stratification and Early Optimization of Renal Risk Medications among Older Patients in the Emergency Department.

Baker Nawfal Jawad,Jesper Eugen-Olsen,Morten Baltzer Houlind,Ove Andersen,Esben Iversen,Mads Hornum,Helle Gybel Juul-Larsen,Thomas Kallemose,Anne Kathrine Bengaard,Camilla Ngoc Nguyen,Anne Byriel Walls

doi:10.3390/ph14090843

Abstract

Diagnosis of acute kidney injury (AKI) based on plasma creatinine often lags behind actual changes in renal function. Here, we investigated early detection of AKI using the plasma soluble urokinase plasminogen activator receptor (suPAR) and neutrophil gelatinase-sssociated lipocalin (NGAL) and observed the impact of early detection on prescribing recommendations for renally-eliminated medications. This study is a secondary analysis of data from the DISABLMENT cohort on acutely admitted older (≥65 years) medical patients (n = 339). Presence of AKI according to kidney disease: improving global outcomes (KDIGO) criteria was identified from inclusion to 48 h after inclusion. Discriminatory power of suPAR and NGAL was determined by receiver-operating characteristic (ROC). Selected medications that are contraindicated in AKI were identified in Renbase®. A total of 33 (9.7%) patients developed AKI. Discriminatory power for suPAR and NGAL was 0.69 and 0.78, respectively, at a cutoff of 4.26 ng/mL and 139.5 ng/mL, respectively. The interaction of suPAR and NGAL yielded a discriminatory power of 0.80, which was significantly higher than for suPAR alone (p = 0.0059). Among patients with AKI, 22 (60.6%) used at least one medication that should be avoided in AKI. Overall, suPAR and NGAL levels were independently associated with incident AKI and their combination yielded excellent discriminatory power for risk determination of AKI.

Highlights

This article is an open access articleOlder people (≥65 years) represent a large and growing demographic worldwide [1,2].In 2018 alone, approximately 465,000 older people in Denmark were admitted to an emergency department (ED) [3,4]
We found that plasma neutrophil gelatinase-sssociated lipocalin (NGAL) alone yielded an Area under the curve (AUC) of 0.78 for the development of acute kidney injury (AKI), while the addition of soluble urokinase plasminogen activator receptor (suPAR) improved the AUC to 0.82
In clinical settings where suPAR is already implemented as a standard biomarker, we suggest that suPAR in combination with C-reactive protein (CRP) should be utilized for AKI risk stratification

Summary

Introduction

This article is an open access article. Older people (≥65 years) represent a large and growing demographic worldwide [1,2]. In 2018 alone, approximately 465,000 older people in Denmark were admitted to an emergency department (ED) [3,4]. Acute kidney injury (AKI) occurs in 3–12% of hospitalized patients and is associated with an increased risk of medication-related toxicity, prolonged hospitalization and mortality [5–8]. The incidence of AKI is high among older distributed under the terms and conditions of the Creative Commons. Pharmaceuticals 2021, 14, 843 patients [9], who are characterized by multiple comorbid conditions that contribute to AKI development [10,11]. Increasing age is associated with lower baseline glomerular filtration rate (GFR), which predisposes older patients to develop clinically relevant AKI [9,12]

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Discussion

Conclusion