Serum Cystatin C is Associated with Renal Function Recovery in Critically Ill Patients Undergoing Continuous Renal Replacement Therapy

Zhang, Z.; Xu, Xiaomei; Ni, Hongying; Jin, Ning

doi:10.1159/000350245

Cited by 12 publications

(14 citation statements)

References 24 publications

(25 reference statements)

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“…The level of CysC was observed to be relatively stable during continuous venovenous hemofiltration, suggesting that CysC can be used to monitor residual renal function during and immediately after RRT . Upon the initiation of RRT, serum CysC has been reported to be predictive of short‐term renal function recovery (P < 0.01), and it is not surprising that sCysC showed the greatest AUC value for predicting renal recovery in our study. Uchino et al found that UO was the most important predictor of successful discontinuation of RRT (AUC 0.808).…”

Section: Discussionsupporting

confidence: 52%

Biomarkers upon discontinuation of renal replacement therapy predict 60‐day survival and renal recovery in critically ill patients with acute kidney injury

Yang

Sun

Zhao

et al. 2017

Hemodialysis International

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Introduction: There is no consensus on the specific indications for weaning critically ill patients with acute kidney injury (AKI) off renal replacement therapy (RRT). This study aimed to explore the prognostic value of several biomarkers measured upon discontinuation of RRT for their value in predicting 60-day survival and renal recovery in an effort to add knowledge to the decision-making process regarding RRT withdrawal. Methods:We prospectively enrolled 102 patients with AKI who required RRT from the intensive care unit. Serum osteopontin (sOPN), serum interleukin 6 (sIL-6), serum cystatin C (sCysC), sIL-18, serum neutrophil gelatinase-associated lipocalin and urinary IL-18 and urinary neutrophil gelatinase-associated lipocalin were measured upon discontinuation of RRT. Patients were followed up at 60 days for survival and renal recovery. Findings:Patients who survived showed lower levels of all serum and urinary biomarkers. Serum OPN (OR 1.029, 95% CI 1.013-1.047, P 5 0.001), diabetes (OR 23.157, 95% CI 4.507-118.981, P < 0.001) and APACHE II score (OR 1.308, 95% CI 1.121-1.527, P 5 0.001) were independent predictors of 60-day mortality. Patients whose sOPN values fell within the highest and middle tertiles showed 5.25-and 2.31-fold increased risks of mortality, respectively, compared with that of patients in the lowest tertile. The addition of sOPN to the clinical model resulted in significant net reclassification improvement of 0.453 (P 5 0.026) and an integrated discriminative index of 0.155 (P 5 0.032). Lower levels of sOPN and sIL-6 were associated with greater odds of 60-day survival (AUC 0.812 and 0.741). The AUC value for predicting survival reached its highest level when all biomarkers were combined with urine output (UO) and urinary and serum creatinine upon discontinuation of RRT (0.882). Lower sCysC performed as well as higher UO in predicting 60-day renal recovery with the greatest AUC of 0.743.Discussion: Upon discontinuation of RRT, serum and urinary biomarkers, particularly sOPN, may predict 60-day survival and renal recovery in critically ill patients with AKI. The serum levels of OPN, IL-6 and CysC may be useful when considering withdrawal of RRT on the basis of conventional indicators.

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Section: Discussionsupporting

confidence: 52%

Biomarkers upon discontinuation of renal replacement therapy predict 60‐day survival and renal recovery in critically ill patients with acute kidney injury

Yang

Sun

Zhao

et al. 2017

Hemodialysis International

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“…This suggests that the diagnostic performance of CysC in predicting renal recovery is clinically useful. However, it has been unclear whether serum CysC at cessation is an optimal indicator for successful weaning from CRRT, since prior studies focused on CysC levels at the time of CRRT initiation but not at its cessation [20]. Concerning this, our study found that serum CysC, at the time of CRRT cessation, was significantly predictive in the successfully weaned group during follow-up, with an AUC value of 0.739.…”

Section: Discussionmentioning

confidence: 59%

“…Therefore, serum CysC could be an optimal marker, not only for the diagnosis of chronic kidney disease, but also for predicting AKI [12]. Zhang et al [20] performed a retrospective study, and showed that higher serum CysC is associated with poor renal recovery and a longer dependence on CRRT in critically ill patients. This suggests that the diagnostic performance of CysC in predicting renal recovery is clinically useful.…”

Section: Discussionmentioning

confidence: 99%

A Prospective Observational Study on the Predictive Value of Serum Cystatin C for Successful Weaning from Continuous Renal Replacement Therapy

Kim¹,

Bae²,

Kwon³

et al. 2018

Kidney Blood Press Res

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Background/Aims: There is a paucity of literature that investigates a biomarker associated with successful renal recovery following continuous renal replacement therapy (CRRT). Our study aimed to identify potential renal biomarkers or clinical indicators that could predict the successful weaning from CRRT. Methods: We conducted a prospective, observational study of 110 patients who had received CRRT and were weaned after renal recovery. Patients were considered to have successfully weaned from CRRT once there was no need for renal replacement therapy (RRT) for at least 14 days. For patients who had to restart dialysis within 14 days were considered unsuccessful. Results: Of the 110 patients evaluated, 89 (80.9%) were successfully weaned from CRRT. These patients had lower serum cystatin C (CysC) levels and higher urine output than the group that restarted RRT at the time of CRRT cessation. However, the levels of serum creatinine and neutrophil gelatinase-associated lipocalin were not significantly lower in the successful group compared to the restart-RRT group. A multivariable logistic regression showed that serum CysC was an independent predictor for the successful weaning from CRRT. Furthermore, in a multivariable Cox proportional hazards analysis, the group that was successfully weaned from CRRT had a lower in-hospital mortality compared to the restarted RRT group. Conclusion: Serum CysC, at the time of CRRT cessation, is an independent predictor of the successful weaning from CRRT in critically ill patients with acute kidney injury.

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“…CysC is a nonglycosylated basic peptide produced steadily and continuously by all nucleated cells, and its concentration is not affected by age, sex, and changes in muscle mass. The CysC level upon the initiation of RRT has been reported to be a predictor of short-term renal outcome (18). It is the only candidate functional marker of AKI that has been considered to replace creatinine (9).…”

Section: Discussionmentioning

confidence: 99%

“…decreased creatinine level upon the discontinuation of RRT was found to be a predictor of successful discontinuation (OR 0.996, P < 0.001); however, CysC was not studied, and the observed outcome was independence from dialysis for a short time period. The CysC level upon the initiation of RRT has been reported to be a predictor of short-term renal outcome (18). The association of CysC upon the discontinuation of RRT and long-term dialysis dependence has not been explored.…”

Section: Discussionmentioning

confidence: 99%

Predictive Factors Upon Discontinuation of Renal Replacement Therapy for Long‐Term Chronic Dialysis and Death in Acute Kidney Injury Patients

et al. 2017

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The specific timing for discontinuing renal replacement therapy (RRT) in acute kidney injury (AKI) patients is debatable. The predictive abilities of variables at the time of discontinuation of RRT for the long-term prognoses of patients have not been explored. This study aimed to explore the prognostic factors upon discontinuation of RRT for long-term chronic dialysis and death of patients with acute RRT-requiring AKI, thus improving decision making regarding the discontinuation of RRT and the follow-up of patients thereafter. A cohort of 302 AKI patients who required acute RRT and remained alive and free of dialysis for at least 30 days after discharge from January 2009 to December 2012 were followed up. The predictive abilities of general characteristics, RRT details, and variables upon discontinuation of RRT for long-term chronic dialysis and all-cause death were evaluated using Cox proportional hazards models. Kaplan-Meier analysis with a log-rank test was used to compare the survival curves between the strata of levels of good predictors upon discontinuation of RRT. After a median follow-up time of 4.1 years, 20 (6.6%) patients initiated chronic dialysis and 56 (18.5%) patients died. A higher CysC level upon discontinuation of RRT (HR 1.520, 95% CI 1.082-2.135; P = 0.016), comorbid chronic kidney disease, and a higher non-renal Charlson comorbidity index (CCI) were independently predictive for chronic dialysis. The hemoglobin level upon discontinuation of RRT was inversely predictive of death (HR 0.986, 95% CI 0.973-0.999; P = 0.035), and comorbid malignancy, the presence of multiple organ dysfunction syndrome, and a higher non-renal CCI also predicted death. Urine output upon discontinuation of RRT was marginally inversely predictive of death (HR 0.997, 95% CI 0.994-1.000; P = 0.056). Patients who discontinued RRT with CysC levels <2.97 mg/L, hemoglobin levels >85 g/L, and urine output >1130 mL/24 h showed significantly higher non-chronic dialysis and survival rates according to a log-rank test. Our study suggested that upon discontinuation of RRT, higher serum CysC levels had the most promising predictive value for long-term chronic dialysis, and lower hemoglobin levels predicted long-term death; lower urine output also marginally predicted long-term death. Based on the remission of the comprehensive condition, lower CysC levels and higher hemoglobin levels and urine output should be considered in the decision to stop RRT. Patients showing worse levels of these indices upon discontinuation of RRT should undergo stricter follow-up and treatment to improve long-term outcomes.

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Serum Cystatin C is Associated with Renal Function Recovery in Critically Ill Patients Undergoing Continuous Renal Replacement Therapy

Cited by 12 publications

References 24 publications

Biomarkers upon discontinuation of renal replacement therapy predict 60‐day survival and renal recovery in critically ill patients with acute kidney injury

Biomarkers upon discontinuation of renal replacement therapy predict 60‐day survival and renal recovery in critically ill patients with acute kidney injury

A Prospective Observational Study on the Predictive Value of Serum Cystatin C for Successful Weaning from Continuous Renal Replacement Therapy

Predictive Factors Upon Discontinuation of Renal Replacement Therapy for Long‐Term Chronic Dialysis and Death in Acute Kidney Injury Patients

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