TY - JOUR
T1 - First post-operative urinary kidney injury biomarkers and association with the duration of AKI in the TRIBE-AKI cohort
AU - TRIBE-AKI Consortium
AU - Coca, Steven G.
AU - Nadkarni, Girish N.
AU - Garg, Amit X.
AU - Koyner, Jay
AU - Thiessen-Philbrook, Heather
AU - McArthur, Eric
AU - Shlipak, Michael G.
AU - Parikh, Chirag R.
AU - Raman, Jai
AU - Jeevanandam, Valluvan
AU - Akhter, Shahab
AU - Edelstein, Charles
AU - Passik, Cary
AU - Nagy, Judy
AU - Swaminathan, Madhav
AU - Chu, Michael
AU - Goldbach, Martin
AU - Guo, Lin Ruo
AU - McKenzie, Neil
AU - Myers, Mary Lee
AU - Novick, Richard
AU - Quantz, Mac
AU - Zappitelli, Michael
AU - Palijan, Ana
AU - Dewar, Michael
AU - Darr, Umer
AU - Hashim, Sabet
AU - Elefteriades, John
AU - Geirsson, Arnar
AU - Garwood, Susan
AU - Butrymowicz, Isabel
AU - Krumholz, Harlan
N1 - Funding Information:
This study was supported by the Institute for Clinical Evaluative Sciences (ICES), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES or the MOHLTC is intended or should be inferred. This study was supported by the National Institutes of Health (NIH) (R01HL085757 to CRP) to fund the TRIBE-AKI Consortium to study novel biomarkers of AKI in cardiac surgery. SGC has been supported by an NIH Career Development Award (K23DK080132). GNN is supported in part by the NIH (T32- DK007757). JLK has been supported by K23 DK081616. C.R.P. is supported by the NIH (K24DK090203) and P30 DK079310-07 O'Brien Center Grant. SGC, AXG, and CRP are also members of the NIH-sponsored Assess, Serial Evaluation, and Subsequent Sequelae in Acute Kidney Injury Consortium (U01DK082185). AXG is supported by the Dr. Adam Linton Chair in Kidney Health Analytics.
Publisher Copyright:
© 2016 Coca et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2016/8
Y1 - 2016/8
N2 - Background: We previously demonstrated that assessment of the duration of AKI, in addition to magnitude of rise in creatinine alone, adds prognostic information for long-term survival. We evaluated whether post-operative kidney injury biomarkers in urine collected immediately after cardiac surgery associate with duration of serum creatinine elevation. Methods: We studied 1199 adults undergoing cardiac surgery in a prospective cohort study (TRIBEAKI) and examined the association between the levels of five urinary biomarkers individually at 0-6 hours after surgery: interleukin-18 (IL-18), neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), liver fatty acid binding protein (L-FABP) and albumin with duration of serum creatinine-based AKIN criteria for AKI (0 (no AKI), 1-2, 3-6, >7 days). Results: Overall, 407 (34%) patients had at least stage 1 AKI, of whom 251 (61.7%) had duration of 1-2 days, 118 (28.9%) had duration 3-6 days, and 38 (9.3%) had duration of >7 days. Higher concentrations of all biomarkers (per log increase) were independently associated with a greater odds of a longer duration of AKI; odds ratios and 95%confidence intervals using ordinal logistic regression were the following: IL-18: 1.22, 1.13-1.32; KIM-1: 1.36, 1.21-1.52; albumin 1.20, 1.09-1.32; L-FABP 1.11, 1.04-1.19; NGAL 1.06, 1.00-1.14). AKI duration of 7 days or longer was associated with a 5-fold adjusted risk of mortality at 3 years. Conclusions: There was an independent dose-response association between urinary levels of injury biomarkers immediately after cardiac surgery and longer duration of AKI. Duration of AKI was also associated with long term mortality. Future studies should explore the potential utility of these urinary kidney injury biomarkers to enrich enrollment of patients at risk for longer duration of AKI into trials of interventions to prevent or treat post-operative AKI.
AB - Background: We previously demonstrated that assessment of the duration of AKI, in addition to magnitude of rise in creatinine alone, adds prognostic information for long-term survival. We evaluated whether post-operative kidney injury biomarkers in urine collected immediately after cardiac surgery associate with duration of serum creatinine elevation. Methods: We studied 1199 adults undergoing cardiac surgery in a prospective cohort study (TRIBEAKI) and examined the association between the levels of five urinary biomarkers individually at 0-6 hours after surgery: interleukin-18 (IL-18), neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), liver fatty acid binding protein (L-FABP) and albumin with duration of serum creatinine-based AKIN criteria for AKI (0 (no AKI), 1-2, 3-6, >7 days). Results: Overall, 407 (34%) patients had at least stage 1 AKI, of whom 251 (61.7%) had duration of 1-2 days, 118 (28.9%) had duration 3-6 days, and 38 (9.3%) had duration of >7 days. Higher concentrations of all biomarkers (per log increase) were independently associated with a greater odds of a longer duration of AKI; odds ratios and 95%confidence intervals using ordinal logistic regression were the following: IL-18: 1.22, 1.13-1.32; KIM-1: 1.36, 1.21-1.52; albumin 1.20, 1.09-1.32; L-FABP 1.11, 1.04-1.19; NGAL 1.06, 1.00-1.14). AKI duration of 7 days or longer was associated with a 5-fold adjusted risk of mortality at 3 years. Conclusions: There was an independent dose-response association between urinary levels of injury biomarkers immediately after cardiac surgery and longer duration of AKI. Duration of AKI was also associated with long term mortality. Future studies should explore the potential utility of these urinary kidney injury biomarkers to enrich enrollment of patients at risk for longer duration of AKI into trials of interventions to prevent or treat post-operative AKI.
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U2 - 10.1371/journal.pone.0161098
DO - 10.1371/journal.pone.0161098
M3 - Article
C2 - 27537050
AN - SCOPUS:84984856705
VL - 11
JO - PLoS One
JF - PLoS One
SN - 1932-6203
IS - 8
M1 - e0161098
ER -