Abstract

Background: Cardiac surgery–associated acute kidney injury (AKI) is associated with increased morbidity and mortality. We examined the utility of combining biomarkers of kidney function loss (serum cystatin C) and kidney tubular damage (urine neutrophil gelatinase-associated lipocalin [NGAL] and Kidney Injury Molecule-1 [KIM-1]) for the prediction of post–cardiac surgery AKI. Methods: Single-center prospective cohort study of 106 adults undergoing coronary artery bypass grafting and/or valve surgery with cardiopulmonary bypass (CPB). Primary outcome was postoperative in-hospital AKI defined by serum creatinine (SCr)–Kidney Disease: Improving Global Outcomes criteria. Biomarkers were measured preoperatively, 6 hours after CPB and on postoperative days (PODs) 1 to 4. Results: A total of 23 subjects (21.7%) developed AKI. After adjusting for preoperative left ventricular ejection fraction, body mass index >30 kg/m2, and estimated glomerular filtration rate (eGFR) <60 ml/min per 1.73 m2, the combination of peak serum cystatin C and peak urine KIM-1/creatinine (Cr) (6 hours post-CPB to POD 1) above optimal cutoff significantly associated with postoperative AKI (odds ratio [OR]: 5.32; 95% confidence interval [CI]: 1.31–21.67; P = 0.020). This biomarker combination significantly improved the performance of the clinical model for the prediction of postoperative AKI (area under the curve [AUC]: 0.77, 95% CI: 0.65–0.90 for the clinical model alone versus 0.83, 95% CI: 0.73–0.93 for the clinical model with the addition of biomarker data, P = 0.049). Conclusions: Combining biomarkers of postoperative kidney function loss and postoperative kidney tubular damage significantly improved prediction of in-hospital AKI following cardiac surgery. Future large, multicenter studies are warranted to assess whether panels of biomarkers reflecting distinct pathobiology can be used to guide interventions and improve short- and long-term outcomes in patients undergoing cardiac surgery.

Original languageEnglish (US)
JournalKidney International Reports
DOIs
StatePublished - Jan 1 2019

Fingerprint

Acute Kidney Injury
Thoracic Surgery
Biomarkers
Kidney
Cardiopulmonary Bypass
Cystatin C
Confidence Intervals
Creatinine
Serum
Urine
Wounds and Injuries
Kidney Diseases
Glomerular Filtration Rate
Coronary Artery Bypass
Stroke Volume
Multicenter Studies
Area Under Curve
Body Mass Index
Cohort Studies
Odds Ratio

Keywords

  • acute kidney injury
  • biomarkers
  • critical care
  • major adverse kidney events
  • prediction
  • thoracic surgery

ASJC Scopus subject areas

  • Nephrology

Cite this

@article{e27a8f93639f4113a80cef806203e893,
title = "Kidney Tubular Damage and Functional Biomarkers in Acute Kidney Injury Following Cardiac Surgery",
abstract = "Background: Cardiac surgery–associated acute kidney injury (AKI) is associated with increased morbidity and mortality. We examined the utility of combining biomarkers of kidney function loss (serum cystatin C) and kidney tubular damage (urine neutrophil gelatinase-associated lipocalin [NGAL] and Kidney Injury Molecule-1 [KIM-1]) for the prediction of post–cardiac surgery AKI. Methods: Single-center prospective cohort study of 106 adults undergoing coronary artery bypass grafting and/or valve surgery with cardiopulmonary bypass (CPB). Primary outcome was postoperative in-hospital AKI defined by serum creatinine (SCr)–Kidney Disease: Improving Global Outcomes criteria. Biomarkers were measured preoperatively, 6 hours after CPB and on postoperative days (PODs) 1 to 4. Results: A total of 23 subjects (21.7{\%}) developed AKI. After adjusting for preoperative left ventricular ejection fraction, body mass index >30 kg/m2, and estimated glomerular filtration rate (eGFR) <60 ml/min per 1.73 m2, the combination of peak serum cystatin C and peak urine KIM-1/creatinine (Cr) (6 hours post-CPB to POD 1) above optimal cutoff significantly associated with postoperative AKI (odds ratio [OR]: 5.32; 95{\%} confidence interval [CI]: 1.31–21.67; P = 0.020). This biomarker combination significantly improved the performance of the clinical model for the prediction of postoperative AKI (area under the curve [AUC]: 0.77, 95{\%} CI: 0.65–0.90 for the clinical model alone versus 0.83, 95{\%} CI: 0.73–0.93 for the clinical model with the addition of biomarker data, P = 0.049). Conclusions: Combining biomarkers of postoperative kidney function loss and postoperative kidney tubular damage significantly improved prediction of in-hospital AKI following cardiac surgery. Future large, multicenter studies are warranted to assess whether panels of biomarkers reflecting distinct pathobiology can be used to guide interventions and improve short- and long-term outcomes in patients undergoing cardiac surgery.",
keywords = "acute kidney injury, biomarkers, critical care, major adverse kidney events, prediction, thoracic surgery",
author = "Neyra, {Javier A.} and Hu, {Ming C} and Minhajuddin, {Abu Taher M} and Nelson, {Geoffrey E.} and Ahsan, {Syed A.} and Toto, {Robert D} and Jessen, {Michael E} and Moe, {Orson W} and Fox, {Amanda A}",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.ekir.2019.05.005",
language = "English (US)",
journal = "Kidney International Reports",
issn = "2468-0249",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Kidney Tubular Damage and Functional Biomarkers in Acute Kidney Injury Following Cardiac Surgery

AU - Neyra, Javier A.

AU - Hu, Ming C

AU - Minhajuddin, Abu Taher M

AU - Nelson, Geoffrey E.

AU - Ahsan, Syed A.

AU - Toto, Robert D

AU - Jessen, Michael E

AU - Moe, Orson W

AU - Fox, Amanda A

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Cardiac surgery–associated acute kidney injury (AKI) is associated with increased morbidity and mortality. We examined the utility of combining biomarkers of kidney function loss (serum cystatin C) and kidney tubular damage (urine neutrophil gelatinase-associated lipocalin [NGAL] and Kidney Injury Molecule-1 [KIM-1]) for the prediction of post–cardiac surgery AKI. Methods: Single-center prospective cohort study of 106 adults undergoing coronary artery bypass grafting and/or valve surgery with cardiopulmonary bypass (CPB). Primary outcome was postoperative in-hospital AKI defined by serum creatinine (SCr)–Kidney Disease: Improving Global Outcomes criteria. Biomarkers were measured preoperatively, 6 hours after CPB and on postoperative days (PODs) 1 to 4. Results: A total of 23 subjects (21.7%) developed AKI. After adjusting for preoperative left ventricular ejection fraction, body mass index >30 kg/m2, and estimated glomerular filtration rate (eGFR) <60 ml/min per 1.73 m2, the combination of peak serum cystatin C and peak urine KIM-1/creatinine (Cr) (6 hours post-CPB to POD 1) above optimal cutoff significantly associated with postoperative AKI (odds ratio [OR]: 5.32; 95% confidence interval [CI]: 1.31–21.67; P = 0.020). This biomarker combination significantly improved the performance of the clinical model for the prediction of postoperative AKI (area under the curve [AUC]: 0.77, 95% CI: 0.65–0.90 for the clinical model alone versus 0.83, 95% CI: 0.73–0.93 for the clinical model with the addition of biomarker data, P = 0.049). Conclusions: Combining biomarkers of postoperative kidney function loss and postoperative kidney tubular damage significantly improved prediction of in-hospital AKI following cardiac surgery. Future large, multicenter studies are warranted to assess whether panels of biomarkers reflecting distinct pathobiology can be used to guide interventions and improve short- and long-term outcomes in patients undergoing cardiac surgery.

AB - Background: Cardiac surgery–associated acute kidney injury (AKI) is associated with increased morbidity and mortality. We examined the utility of combining biomarkers of kidney function loss (serum cystatin C) and kidney tubular damage (urine neutrophil gelatinase-associated lipocalin [NGAL] and Kidney Injury Molecule-1 [KIM-1]) for the prediction of post–cardiac surgery AKI. Methods: Single-center prospective cohort study of 106 adults undergoing coronary artery bypass grafting and/or valve surgery with cardiopulmonary bypass (CPB). Primary outcome was postoperative in-hospital AKI defined by serum creatinine (SCr)–Kidney Disease: Improving Global Outcomes criteria. Biomarkers were measured preoperatively, 6 hours after CPB and on postoperative days (PODs) 1 to 4. Results: A total of 23 subjects (21.7%) developed AKI. After adjusting for preoperative left ventricular ejection fraction, body mass index >30 kg/m2, and estimated glomerular filtration rate (eGFR) <60 ml/min per 1.73 m2, the combination of peak serum cystatin C and peak urine KIM-1/creatinine (Cr) (6 hours post-CPB to POD 1) above optimal cutoff significantly associated with postoperative AKI (odds ratio [OR]: 5.32; 95% confidence interval [CI]: 1.31–21.67; P = 0.020). This biomarker combination significantly improved the performance of the clinical model for the prediction of postoperative AKI (area under the curve [AUC]: 0.77, 95% CI: 0.65–0.90 for the clinical model alone versus 0.83, 95% CI: 0.73–0.93 for the clinical model with the addition of biomarker data, P = 0.049). Conclusions: Combining biomarkers of postoperative kidney function loss and postoperative kidney tubular damage significantly improved prediction of in-hospital AKI following cardiac surgery. Future large, multicenter studies are warranted to assess whether panels of biomarkers reflecting distinct pathobiology can be used to guide interventions and improve short- and long-term outcomes in patients undergoing cardiac surgery.

KW - acute kidney injury

KW - biomarkers

KW - critical care

KW - major adverse kidney events

KW - prediction

KW - thoracic surgery

UR - http://www.scopus.com/inward/record.url?scp=85068550423&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85068550423&partnerID=8YFLogxK

U2 - 10.1016/j.ekir.2019.05.005

DO - 10.1016/j.ekir.2019.05.005

M3 - Article

C2 - 31440703

AN - SCOPUS:85068550423

JO - Kidney International Reports

JF - Kidney International Reports

SN - 2468-0249

ER -