Biomarkers Predict Progression of Acute Kidney Injury after Cardiac Surgery

Koyner, Jay L.; Garg, Amit X.; Coca, Steven G.; Sint, Kyaw; Thiessen-Philbrook, Heather; Patel, Uptal D.; Shlipak, Michael G.; Parikh, Chirag R.

doi:10.1681/asn.2011090907

Cited by 244 publications

(234 citation statements)

References 39 publications

Supporting

Mentioning

218

Contrasting

Unclassified

Order By: Relevance

“…4,24,25,26 Similar efforts are underway in veterinary medicine and show great promise. [28][29][30][31][32][33][34][35][36] (See also, Yerramilli in this issue) An AKI biomarker should be detectable in urine and/or plasma such that it can be assessed routinely and serve as an indicator of kidney function or dysfunction or response to injury.…”

Section: Identification Of Progressive Ckd: the Search For Active Injmentioning

confidence: 96%

“…4,24,25,26 However, this restricted focus to AKI constrains their broader and potentially important application to CKD. Kidney-specific biomarkers that localize to functional renal tubular epithelia (or other kidney-specific loci) and respond to diverse stresses or disruption of normal cellular function have potential to signal the early, specific, and sensitive existence of kidney injury and are perhaps better termed "active kidney injury" biomarkers.…”

Section: Candidate Biomarkers For Active Kidney Injurymentioning

confidence: 99%

See 1 more Smart Citation

Is Progressive Chronic Kidney Disease a Slow Acute Kidney Injury?

Cowgill

Polzin

Elliott

et al. 2016

Veterinary Clinics of North America: Small Animal Practice

View full text Add to dashboard Cite

Section: Identification Of Progressive Ckd: the Search For Active Injmentioning

confidence: 96%

Section: Candidate Biomarkers For Active Kidney Injurymentioning

confidence: 99%

Is Progressive Chronic Kidney Disease a Slow Acute Kidney Injury?

Cowgill

Polzin

Elliott

et al. 2016

Veterinary Clinics of North America: Small Animal Practice

View full text Add to dashboard Cite

“…Diagnostic mainstays such as the fractional excretion of sodium and urea have been shown to be suboptimal in a variety of clinical settings (13)(14)(15)(16)(17). Assessment of biomarkers for renal tubular injury (e.g., neutrophil gelatinase-associated lipocalin [NGAL], kidney injury molecule-1 [KIM-1] and IL-18) at the time of creatinine-based diagnosis of AKI offers prognostic information in multiple clinical settings such as cardiac surgery, ICU, transplantation, and cirrhosis (18)(19)(20)(21)(22)(23). However, their utility has not been tested in ADHF.…”

Section: Introductionmentioning

confidence: 99%

Urinary Biomarkers at the Time of AKI Diagnosis as Predictors of Progression of AKI among Patients with Acute Cardiorenal Syndrome

Chen¹,

Yang

Lei

et al. 2016

CJASN

View full text Add to dashboard Cite

Background and objectives A major challenge in early treatment of acute cardiorenal syndrome (CRS) is the lack of predictors for progression of AKI. We aim to investigate the utility of urinary angiotensinogen and other renal injury biomarkers in predicting AKI progression in CRS.Design, settings, participants, & measurements In this prospective, multicenter study, we screened 732 adults who admitted for acute decompensated heart failure from September 2011 to December 2014, and evaluated whether renal injury biomarkers measured at time of AKI diagnosis can predict worsening of AKI. In 213 patients who developed Kidney Disease Improving Global Outcomes stage 1 or 2 AKI, six renal injury biomarkers, including urinary angiotensinogen (uAGT), urinary neutrophil gelatinase-associated lipocalin (uNGAL), plasma neutrophil gelatinase-associated lipocalin, urinary IL-18 (uIL-18), urinary kidney injury molecule-1, and urinary albumin-to-creatinine ratio, were measured at time of AKI diagnosis. The primary outcome was AKI progression defined by worsening of AKI stage (50 patients). The secondary outcome was AKI progression with subsequent death (18 patients).Results After multivariable adjustment, the highest tertile of three urinary biomarkers remained associated with AKI progression compared with the lowest tertile: uAGT (odds ratio [OR], 10.8; 95% confidence interval [95% CI], 3.4 to 34.7), uNGAL (OR, 4.7; 95% CI, 1.7 to 13.4), and uIL-18 (OR, 3.6; 95% CI, 1.4 to 9.5). uAGT was the best predictor for both primary and secondary outcomes with area under the receiver operating curve of 0.78 and 0.85. These three biomarkers improved risk reclassification compared with the clinical model alone, with uAGT performing the best (category-free net reclassification improvement for primary and secondary outcomes of 0.76 [95% CI, 0.46 to 1.06] and 0.93 [95% CI, 0.50 to 1.36]; P,0.001). Excellent performance of uAGT was further confirmed with bootstrap internal validation.Conclusions uAGT, uNGAL, and uIL-18 measured at time of AKI diagnosis improved risk stratification and identified CRS patients at highest risk of adverse outcomes.

show abstract

“…Biomarkers were measured on the day of AKI diagnosis in 380 patients who developed at least AKIN stage 1 AKI. (27).…”

Section: Biomarker-assisted Prognosis At the Time Of Clinical Akimentioning

confidence: 99%

“…In the near future, we anticipate that these investigations will include a combination of clinical risk factors and multiple biomarkers to predict the clinical course and prognosis. To date, several investigations have sought to combine AKI biomarkers with clinical information to determine if the addition of the novel marker improves risk stratification (18,19,27,(36)(37)(38). Few studies have incorporated preexisting standardized clinical models/scores (e.g., Acute Physiology, Age, Chronic Health Evaluation [APACHE] or Mehta Score for cardiac surgery) (47), because most of these risk stratification scores were constructed and validated to detect end points other than nondialysis-requiring AKI (26).…”

Section: Clinical Use Of Aki Biomarkers: Moving Forwardmentioning

confidence: 99%

Clinical Utility of Biomarkers of AKI in Cardiac Surgery and Critical Illness

Koyner

Parikh

2013

Clinical Journal of the American Society of Nephrology

Self Cite

View full text Add to dashboard Cite

SummaryAKI is a common and serious complication that is associated with several adverse outcomes in hospitalized patients. The past several years have seen a large number of multicenter investigations of biomarkers of AKI in the setting of cardiac surgery and critical illness. This review summarizes these biomarker results to identify applications for clinical use. The Translational Research Investigating Biomarker Endpoints in AKI (TRIBE-AKI) study showed that blood and urine biomarkers measured preoperatively, immediately postoperatively, and at the time of the clinical increase in serum creatinine in the setting of cardiac surgery all had the ability to improve patient risk stratification for a variety of important clinical end points. Analyses of biomarkers concentrations from the Acute Respiratory Distress Syndrome Network, EARLY ARF, and other studies of critically ill subjects have similarly shown that biomarkers measured early in the clinical course can forecast the development of AKI and need for renal replacement therapy as well as inpatient mortality. Although biomarkers have informed the diagnosis, prognosis, and treatment of AKI and are inching closer to clinical application, large multicenter interventional clinical trials to prevent AKI using biomarkers should continue to be an active area of clinical investigation.

show abstract

Biomarkers Predict Progression of Acute Kidney Injury after Cardiac Surgery

Cited by 244 publications

References 39 publications

Is Progressive Chronic Kidney Disease a Slow Acute Kidney Injury?

Is Progressive Chronic Kidney Disease a Slow Acute Kidney Injury?

Urinary Biomarkers at the Time of AKI Diagnosis as Predictors of Progression of AKI among Patients with Acute Cardiorenal Syndrome

Clinical Utility of Biomarkers of AKI in Cardiac Surgery and Critical Illness

Contact Info

Product

Resources

About