The kidney in critical illness: How to monitor a pivotal organ system

Heringlake, Matthias; Schön, Julika; Paarmann, Hauke

doi:10.1016/j.bpa.2013.06.003

Cited by 8 publications

(4 citation statements)

References 33 publications

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“…Several mechanisms mediating a perioperative decrease in renal function have been identified within recent years and several biomarkers have been proposed to facilitate early detection of AKI, i.e., neutrophil-gelatinase-associated lipocalin (NGAL), kidney-injury molecule -1 (KIM-1), liver-type fatty acid binding protein (L-FABP), interleukin-18 (IL-18), insulin-like growth factor-binding protein 7 (IGFBP7), and tissue inhibitor of metalloproteinase (TIMP-2) [ 17 ]. However, these biomarkers are intended for the early detection of AKI after a renal insult has occurred and not for preoperative risk stratification.…”

Section: Discussionmentioning

confidence: 99%

Preoperative plasma growth-differentiation factor-15 for prediction of acute kidney injury in patients undergoing cardiac surgery

et al. 2016

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BackgroundGrowth-differentiation factor-15 (GDF-15) is an emerging humoral marker for risk stratification in cardiovascular disease. Cardiac-surgery-associated acute kidney injury (CSA-AKI), an important complication in patients undergoing cardiac surgery, is associated with poor prognosis. The present secondary analysis of an observational cohort study aimed to determine the role of GDF-15 in predicting CSA-AKI compared with the Cleveland-Clinic Acute Renal Failure (CC-ARF) score and a logistic regression model including variables associated with renal dysfunction.MethodsPreoperative plasma GDF-15 was determined in 1176 consecutive patients undergoing elective cardiac surgery. Patients with chronic kidney disease stage 5 were excluded. AKI was defined according to Kidney-Disease-Improving-Global-Outcomes (KDIGO) - creatinine criteria. The following variables were screened for association with development of postoperative AKI: age, gender, additive Euroscore, serum creatinine, duration of cardiopulmonary bypass, duration of surgery, type of surgery, total circulatory arrest, preoperative hemoglobin, preoperative oxygen-supplemented cerebral oxygen saturation, diabetes mellitus, hemofiltration during ECC, plasma GDF-15, high sensitivity troponin T (hsTNT), and N-terminal prohormone of B-type natriuretic peptide (NTproBNP).ResultsThere were 258 patients (21.9 %) with AKI (AKI stage 1 (AKI-1), n = 175 (14.9 %); AKI-2, n = 6 (0.5 %); AKI-3, n = 77 (6.5 %)). The incidence of AKI-1 and AKI-3 increased significantly from the lowest to the highest tertiles of GDF-15. In logistic regression, preoperative GDF-15, additive Euroscore, age, plasma creatinine, diabetes mellitus, and duration of cardiopulmonary bypass were independently associated with AKI. Inclusion of GDF-15 in a logistic regression model comprising these variables significantly increased the area under the curve (AUC 0.738 without and 0.750 with GDF-15 included) and the net reclassification ability to predict AKI. Comparably, in receiver operating characteristic analysis the predictive capacity of the CC-ARF score (AUC 0.628) was improved by adding GDF-15 (AUC 0.684) but this score also had lower predictability than the logistic regression model. In random forest analyses the predictive capacity of GDF-15 was especially pronounced in patients with normal plasma creatinine.ConclusionThis suggests that preoperative plasma GDF-15 independently predicts postoperative AKI in patients undergoing elective cardiac surgery and is particularly helpful for risk stratification in patients with normal creatinine.Trial registration NCT01166360 on July 20, 2010.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1482-3) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Preoperative plasma growth-differentiation factor-15 for prediction of acute kidney injury in patients undergoing cardiac surgery

et al. 2016

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“…Since renal dysfunction is associated with higher morbidity and mortality in the elderly [2, 3], further studies are needed to assess and diagnose it in this population. Although several parameters have been reported as biomarkers for estimating renal function, few studies have explored them in the elderly [4]. …”

Section: Introductionmentioning

confidence: 99%

Association between Plasma Levels of Growth Differentiation Factor-15 and Renal Function in the Elderly: Korean Frailty and Aging Cohort Study

Kim

Won

et al. 2019

Kidney Blood Press Res

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Background/Aims: Growth differentiation factor-15 (GDF-15) expression has been reported to increase in response to tissue damage and has recently emerged as a useful biomarker for various diseases. Although emerging evidence supports the clinicopathological value of GDF-15 in renal impairment, few studies have analyzed it in the elderly. Thus, we conducted a cross-sectional study to investigate the association of plasma GDF-15 with renal function and the presence of chronic kidney disease (CKD) in community-dwelling elderly. Materials: The present study was based on the baseline data of the Korean Frailty and Aging Cohort Study (KFACS), a nationwide cohort study that began in 2016. Of the 1,559 participants assessed in the first year, 443 with available plasma GDF-15 data were enrolled in this study. We investigated the association of plasma GDF-15 levels with clinical and biochemical parameters. The study population was divided into two groups according to renal function (CKD and non-CKD groups) to investigate whether GDF-15 can determine the presence of renal dysfunction in the elderly. Plasma GDF-15 was measured by enzyme-linked immunosorbent assay (ELISA) kit. Results: In a simple regression analysis, the levels of plasma GDF-15 were negatively correlated with estimated glomerular filtration rate (eGFR; r = –0.383, p < 0.001). In multiple linear regression analysis, GDF-15 levels were still significantly correlated with eGFR, even after adjusting for other parameters (r = –0.259, p < 0.001). Plasma GDF-15 levels were significantly higher in the elderly with CKD than in those without CKD (2,364.025 ± 1,052.23 ng/L and 1,451.23 ± 835.79 ng/L, respectively; p < 0.001). The optimal cut-off value of plasma GDF-15 for detecting the presence of CKD was 1,699.4 ng/L (76.5% sensitivity and 76.0% specificity), as determined by the receiver operating characteristic curve. The area under the curve was 0.793 ± 0.033 (95% CI 0.729–0.857, p < 0.001). Conclusion: Plasma GDF-15 levels were negatively associated with eGFR and were significantly increased in the elderly with CKD. Our results suggested that plasma GDF-15 might be a useful marker for discriminating renal impairment in the elderly. Further large and prospective outcome studies of extended duration are needed.

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“…Various factors, including ischemia and ischemia-reperfusion injury, inflammation and oxidative stress, exogenous and endogenous toxins, metabolic abnormalities, and neurohormonal activation may cause renal CSA-AKI. They can be divided into three factors: hemodynamic, inflammatory, and nephrotoxic [39].…”

Section: Classificationmentioning

confidence: 99%

Acute kidney injury after coronary artery bypass graft surgery: a narrative review of causes, diagnosis, and prevention

Jannati¹,

Kojuri²

2021

fmpcr

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Acute kidney injury (AKI) after coronary artery bypass grafting (CABG) is a common cardiac event associated with short and long-term consequences and occurs in 30-51% of CABG patients. AKI may be associated with many other factors and is also responsible for many other pathologies. An increased level of serum creatinine (SCr) after surgery is one of the signs of AKI that may occur more often during cardiopulmonary bypass (CPB) in susceptible individuals. Preparing preoperative checklists is a good practice for the prevention of AKI. Defining new opportunities and strategies of perioperative care is a useful procedure for decreasing the risk of AKI after cardiac surgery. Collecting more data on preoperative risk factors and improving the intraoperative practices may decrease the incidence of AKI in the aggregate population. In this review study, we are going to review the literature on the pathophysiology of AKI and introduce the discussion about the features of patients who are more at the risk of AKI than others.

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The kidney in critical illness: How to monitor a pivotal organ system

Cited by 8 publications

References 33 publications

Preoperative plasma growth-differentiation factor-15 for prediction of acute kidney injury in patients undergoing cardiac surgery

Preoperative plasma growth-differentiation factor-15 for prediction of acute kidney injury in patients undergoing cardiac surgery

Association between Plasma Levels of Growth Differentiation Factor-15 and Renal Function in the Elderly: Korean Frailty and Aging Cohort Study

Acute kidney injury after coronary artery bypass graft surgery: a narrative review of causes, diagnosis, and prevention

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