Serum uric acid may predict development of progressive acute kidney injury after open heart surgery

Abstract

Objectives: Acute kidney injury (AKI) is a common complication of cardiac surgery developing in 25-35% cases. Recently, neutrophil gelatinase-associated lipocalin (NGAL) was shown to predict AKI development earlier than serum creatinine. Some studies demonstrated the predictive role of post-operative serum uric acid (SUA) as an early marker of AKI. We aimed to study the role of serum and urine NGAL as well as SUA to predict progression of AKI. Design and methods: This is a prospective observational study of patients undergoing cardiac surgery. Blood and urine samples for measurement of uric acid, serum and urine NGAL levels were collected prior to cardiac surgery (0 h), and in the time course at 2nd and 24th hours after surgery. Patients who developed AKI were divided into two subgroups as progressing and non-progressing AKI.Results: Sixty patients (42 males, 18 females) were included. After cardiac surgery, 40 patients developed AKI, 20 of whom non-progressing AKI, and 20 progressing AKI. All of the markers significantly increased in AKI patients. A receiver operator characteristics (ROC) curve analysis showed higher predictive ability of SUA for progressing AKI compared with serum and urine NGAL. When compared markers obtained at the second hour after surgery, UA had significantly large AUC than NGAL to predict AKI developed at 24 and 48 h, particularly in patients, who require renal replacement therapy (RRT). Conclusion: Uric acid seems to predict the progression of AKI and RRT requirement in patients underwent cardiac surgery better than NGAL.

Serum uric acid and acute kidney injury: A mini review

“…Recently our group reported that even modest hyperuricemia increases the risk for AKI following aortic aneurysm repair or cardiovascular surgery [38], [39]. In one study, hyperuricemia (preoperative serum uric acid >7 mg/dL) was found to confer a 35-fold increased risk for AKI that was independent of other risk factors including a baseline reduction in eGFR [40].…”

Serum Uric Acid Exhibits Inverse Relationship with Estimated Glomerular Filtration Rate

“…Serum uric acid (SUA) is an independent risk factor for acute kidney injury (AKI) in cardiac surgery patients [1,2,3,4,5]. SUA is also an independent predictor of tumor lysis syndrome (TLS) in acute myeloid leukemia (AML) patients and has comparable discriminative performance with traditional and cytogenetic-based prediction models of TLS [6].…”

Evaluation of Serum Biomarkers in High Risk Acute Kidney Injury Patients for their Early Detection and Risk Assessment

“…Recently Kim JH et al investigated association between uric acid level and mortality and AKI after paraquat intoxication and found significantly higher level of UA in AKI and death groups 8 . Gaipov A et al also reported higher prediction capability of AKI at 24 and 48 hrs with UA and with NGAL, in open heart surgery patients 9 . Apart from an early marker of AKI, UA is now also becoming a potential therapeutic target in kidney diseases 10,11 .…”