A B S T R A C TAnemia contributes to increased morbidity and mortality in chronic kidney diseasepatients. The pathogenesis of anemia in these patients is multifactorial, but thecontribution of erythropoietin deficiency becomes greater as glomerular filtrationrate declines which related to decreased nephron mass. The current standard ofcare includes supplemental iron, erythropoiesis-stimulating agents (ESA), and redblood cell transfusions, although each has drawbacks. Lately, concern has arisenfollowing randomized clinical trials showing that higher hemoglobin targets and/orhigh ESA doses may cause significant harm including increasing cardiovascular andthrombotic events, and even death. Recent experimental and clinical studies showthe promising efficacy of hypoxia inducible factor (HIF) stabilizer which stimulatesendogenous erythropoietin production and enhance iron availability.
Background. Acute kidney injury (AKI) is a common and serious medical condition associated with significant increases in morbidity, mortality, cost of care and non recovery of kidney function that leads to progression to chronic kidney disease. Cell cycle arrest is implicated in the pathogenesis and repair process following AKI. The urinary cell-cycle arrest markers tissue inhibitor of metalloproteinase-2 (TIMP-2) and insulin-like growth factor binding protein 7 (IGFBP-7) have been utilized to predict the risk of AKI in many studies from specific population with good performance. However, their use in predicting recovery is still lacking. The aim of this study was to determine the association between two novel AKI biomarkers, urinary TIMP2 and IGFBP7 and renal recovery after 7 days of treatment in AKI patients at Dr. Mohammad Hoesin Hospital Palembang. Method. This was a prospective cohort study conducted in dr. Mohammad Hoesin Hospital Palembang from January 2021 until March 2021. Subjects enrolled in this study were patients whom diagnosed AKI based on KDIGO 2012 criteria. Urine samples were collected upon patients’ enrollment within 24 hours of AKI diagnosis. We utilized Sandwich Enzyme Linked Immunosorbant Assay (ELISA) method to detect urinary TIMP-2 and IGFBP-7 levels. The primary outcome is recovery from AKI after 7 days of treatment. Chi square test is used to analyze the association between urinary TIMP-2 and IGFBP-7 levels and renal recovery. Results. There were 70 subjects, only 22 of them were recovered after 7 days (31%). Median of urinary TIMP-2 and IGFBP-7 was 0,0047(0,0001-0,1439) [(ng/ml)2/1000]. There was significant association between urinary TIMP2 and IGFBP7 and renal recovery (p=0,027; OR 3,19; 95% CI 1,116-9,128). Conclusion. There was significant association between urinary TIMP2 and IGFBP7 and renal recovery in AKI patients.
Anemia contributes to increased morbidity and mortality in chronic kidney disease patients. The pathogenesis of anemia in these patients is multifactorial, but the contribution of erythropoietin deficiency becomes greater as glomerular filtration rate declines which related to decreased nephron mass. The current standard of care includes supplemental iron, erythropoiesis-stimulating agents (ESA), and red blood cell transfusions, although each has drawbacks. Lately, concern has arisen following randomized clinical trials showing that higher hemoglobin targets and/or high ESA doses may cause significant harm including increasing cardiovascular and thrombotic events, and even death. Recent experimental and clinical studies show the promising efficacy of hypoxia inducible factor (HIF) stabilizer which stimulates endogenous erythropoietin production and enhance iron availability.
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