Risk of Poor Outcomes with Novel and Traditional Biomarkers at Clinical AKI Diagnosis

Hall, Isaac E.; Coca, Steven G.; Perazella, Mark A.; Eko, Umo U.; Luciano, Randy L.; Peter, Patricia; Han, Won Kon; Parikh, Chirag R.

doi:10.2215/cjn.04960511

Cited by 107 publications

(88 citation statements)

References 38 publications

(25 reference statements)

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“…predicting worsening of AKI has also been confirmed in other settings (22,38,39). Consistently, our results confirmed the ability of uIL-18 and uNGAL to predict worsening of AKI in acute CRS.…”

Section: Discussionsupporting

confidence: 89%

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

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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.

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Section: Discussionsupporting

confidence: 89%

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

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“…Moreover, it should stratify risk and identify AKI subtypes [1,27,67,68] . A single biomarker that can fulfill all these criteria has yet to emerge [69] .…”

Section: Aki Biomarkers Creatinine As a Biomarkermentioning

confidence: 99%

“…In recent years, more than 20 biomarkers have been introduced and most of them have been tested in studies of post-cardiac surgery [68,76] . Four novel biomarkers have been studied most frequently: neutrophil gelatinase-associated lipocalin (NGAL), interlukin-18 (IL-18), kidney injury molecule-1 (KIM-1) as markers of tubular injury and cystatin C as a marker of glomerular function.…”

Section: Aki Biomarkers Creatinine As a Biomarkermentioning

confidence: 99%

Serum creatinine role in predicting outcome after cardiac surgery beyond acute kidney injury

Najafi

2014

WJC

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Serum creatinine is still the most important determinant in the assessment of perioperative renal function and in the prediction of adverse outcome in cardiac surgery. Many biomarkers have been studied to date; still, there is no surrogate for serum creatinine measurement in clinical practice because it is feasible and inexpensive. High levels of serum creatinine and its equivalents have been the most important preoperative risk factor for postoperative renal injury. Moreover, creatinine is the mainstay in predicting risk models and risk factor reduction has enhanced its importance in outcome prediction. The future perspective is the development of new definitions and novel tools for the early diagnosis of acute kidney injury largely based on serum creatinine and a panel of novel biomarkers.

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“…Most recently, Hall and coworkers undertook a prospective cohort study to evaluate traditional urine biomarkers and novel urine biomarkers in hospitalized patients who developed early AKI according to the AKIN criteria (24). They tested the utility of these biomarkers in predicting several clinical outcomes as well as differentiating various forms of AKI.…”

Section: Traditional Versus Novel Urine Biomarkersmentioning

confidence: 99%

Traditional Urinary Biomarkers in the Assessment of Hospital-Acquired AKI

Perazella

Coca

2012

Clinical Journal of the American Society of Nephrology

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SummaryTraditional biomarkers, such as urine chemistries and urine microscopic elements, are used in the diagnosis and care of patients with AKI. Urine chemistries, such as fractional excretion of sodium and fractional excretion of urea, are useful for differentiating prerenal AKI from acute tubular necrosis only in select patients. Urine microscopy using a quantitative evaluation of the urine sediment for renal tubular epithelial cells, renal tubular epithelial cell casts, and granular casts has recently been shown to differentiate prerenal AKI from acute tubular necrosis and also provide prognostic information. Urine microscopy has also been noted to compare favorably with new urine biomarkers for diagnosis and prognosis of AKI. Thus, current information on urine diagnostics suggests that urine chemistries have a limited role in differential diagnosis of AKI, whereas urine microscopy and new urine biomarkers may be used together to differentiate prerenal AKI from acute tubular necrosis and predict such outcomes as worsened AKI, acute dialysis, and death.

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Risk of Poor Outcomes with Novel and Traditional Biomarkers at Clinical AKI Diagnosis

Cited by 107 publications

References 38 publications

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

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

Serum creatinine role in predicting outcome after cardiac surgery beyond acute kidney injury

Traditional Urinary Biomarkers in the Assessment of Hospital-Acquired AKI

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