The Association of Angiogenesis Markers With Acute Kidney Injury and Mortality After Cardiac Surgery

Abstract

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Angiogenesis Markers and Recovery From Acute Kidney Injury: A Piece of the Puzzle?

“…The results presented by Mansour et al 7 corroborate the concept that enhanced formation of neovascularization can help preserve peritubular capillaries, mitigate tubulointerstitial fibrosis, and stabilize kidney function after injury. 11,12 However, unknown factors may influence the relationship between angiogenic markers and AKI or mortality.…”

“…In this issue of AJKD, 3 markers of angiogenesis are reported from the TRIBE-AKI cohort, a large multicenter prospective study performed between 2007 and 2010 in 1,444 patients at high risk for AKI undergoing cardiac surgery. 7 Of the cohort, 492 (34%) developed AKI (88% had stage 1) and only 8% had prolonged AKI (≥7 days). After 1 year, 6% of participants had died.…”

“…High postoperative plasma levels of proangiogenic markers, vascular endothelial growth factor A isoform (VEGF) and placental growth factor (PGF), were independently associated with reduced risk for AKI ( 7 In contrast, high postoperative levels of an anti-angiogenic marker, soluble VEGF receptor 1 (sVEGFR1), also known as sFlt-1, were independently associated with increased risk for AKI (aOR, 1.56; 95% CI, 1.31-1.87), prolonged AKI (aOR, 1.56; 95% CI, 1.31-1.87), and mortality (aOR, 2.28; 95% CI, 1.61-3.22). 7 Except for VEGF, preoperative markers were not associated with AKI or outcomes. However, all postoperative angiogenic markers, measured within 6 hours after surgery, were associated with outcomes after multivariable adjustment.…”

Potential targeted therapy and diagnosis based on novel insight into growth factors, receptors, and downstream effectors in acute kidney injury and acute kidney injury-chronic kidney disease progression

“…The Translational Research Investigating Biomarker Endpoints for Acute Kidney Injury (TRIBE-AKI) cohort study on adults undergoing cardiac surgery found that proangiogenic markers, such as VEGF, correlated with a reduced risk of AKI and mortality, but antiangiogenic VEGFR-1 was associated with an increased risk of AKI and mortality. 148 Moreover, VEGF-C and VEGF-D, which are the main ligands for lymphangiogenesis, are abundantly expressed in tubules and increased in the serum and urine after injury. They are involved in renal inflammation and possibly serve as novel urinary biomarkers for AKI and the progression of kidney disease.…”

“…149 In addition, increased urine or plasma FGF-23 levels may be promising novel biomarkers for AKI and other adverse outcomes in critically ill patients. 148,[150][151][152] A previous study also showed that low IGF-1 levels might serve as mortality predictors in AKI patients in the ICU. 89…”