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Urine Biomarkers and Perioperative Acute Kidney Injury: The Impact of Preoperative Estimated GFR.
Am J Kidney Dis. 2015 Dec; 66(6):1006-14.AJ

Abstract

BACKGROUND

The interaction between baseline kidney function and the performance of biomarkers of acute kidney injury (AKI) on the development of AKI is unclear.

STUDY DESIGN

Post hoc analysis of prospective cohort study.

SETTING & PARTICIPANTS

The 1,219 TRIBE-AKI Consortium adult cardiac surgery cohort participants.

PREDICTOR

Unadjusted postoperative urinary biomarkers of AKI measured within 6 hours of surgery.

OUTCOME

AKI was defined as AKI Network stage 1 (any AKI) or higher, as well as a doubling of serum creatinine level from the preoperative value or the need for post-operative dialysis (severe AKI).

MEASUREMENTS

Stratified analyses by preoperative estimated glomerular filtration rate (eGFR) ≤ 60 versus > 60mL/min/1.73m(2).

RESULTS

180 (42%) patients with preoperative eGFRs≤60mL/min/1.73m(2) developed clinical AKI compared with 246 (31%) of those with eGFRs>60mL/min/1.73m(2) (P<0.001). For log2-transformed biomarker concentrations, there was a significant interaction between any AKI and baseline eGFR for interleukin 18 (P=0.007) and borderline significance for liver-type fatty acid binding protein (P=0.06). For all biomarkers, the adjusted relative risk (RR) point estimates for the risk for any AKI were higher in those with elevated baseline eGFRs compared with those with eGFRs≤60mL/min/1.73m(2). However, the difference in magnitude of these risks was low (adjusted RRs were 1.04 [95% CI, 0.99-1.09] and 1.11 [95% CI, 1.07-1.15] for those with preoperative eGFRs≤60mL/min/1.73m(2) and those with higher eGFRs, respectively). Although no biomarker displayed an interaction for baseline eGFR and severe AKI, log2-transformed interleukin 18 and kidney injury molecule 1 had significant adjusted RRs for severe AKI in those with and without baseline eGFRs≤60mL/min/1.73m(2).

LIMITATIONS

Limited numbers of patients with severe AKI and post-operative dialysis.

CONCLUSIONS

The association between early postoperative AKI urinary biomarkers and AKI is modified by preoperative eGFR. The degree of this modification and its impact on the biomarker-AKI association is small across biomarkers. Our findings suggest that distinct biomarker cutoffs for those with and without a preoperative eGFR≤60mL/min/1.73m(2) is not necessary.

Authors+Show Affiliations

Section of Nephrology, Department of Medicine, University of Chicago, Pritzker School of Medicine, Chicago, IL.Department of Internal Medicine, Clinical Epidemiology Research Center, Yale University School of Medicine, New Haven, CT.Division of Nephrology, Department of Medicine, University of Western Ontario, London, Ontario, Canada.Duke University, School of Medicine, Durham, NC.Division of General Internal Medicine, San Francisco VA Medical Center, University of California, San Francisco, CA.Division of Nephrology, Department of Medicine, University of Western Ontario, London, Ontario, Canada.Department of Internal Medicine, Clinical Epidemiology Research Center, Yale University School of Medicine, New Haven, CT. Electronic address: chirag.parikh@yale.edu.No affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Multicenter Study
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

26386737

Citation

Koyner, Jay L., et al. "Urine Biomarkers and Perioperative Acute Kidney Injury: the Impact of Preoperative Estimated GFR." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 66, no. 6, 2015, pp. 1006-14.
Koyner JL, Coca SG, Thiessen-Philbrook H, et al. Urine Biomarkers and Perioperative Acute Kidney Injury: The Impact of Preoperative Estimated GFR. Am J Kidney Dis. 2015;66(6):1006-14.
Koyner, J. L., Coca, S. G., Thiessen-Philbrook, H., Patel, U. D., Shlipak, M. G., Garg, A. X., & Parikh, C. R. (2015). Urine Biomarkers and Perioperative Acute Kidney Injury: The Impact of Preoperative Estimated GFR. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 66(6), 1006-14. https://doi.org/10.1053/j.ajkd.2015.07.027
Koyner JL, et al. Urine Biomarkers and Perioperative Acute Kidney Injury: the Impact of Preoperative Estimated GFR. Am J Kidney Dis. 2015;66(6):1006-14. PubMed PMID: 26386737.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Urine Biomarkers and Perioperative Acute Kidney Injury: The Impact of Preoperative Estimated GFR. AU - Koyner,Jay L, AU - Coca,Steven G, AU - Thiessen-Philbrook,Heather, AU - Patel,Uptal D, AU - Shlipak,Michael G, AU - Garg,Amit X, AU - Parikh,Chirag R, AU - ,, AU - ,, Y1 - 2015/09/16/ PY - 2014/12/09/received PY - 2015/07/18/accepted PY - 2015/9/21/entrez PY - 2015/9/21/pubmed PY - 2016/3/15/medline KW - Urine biomarkers KW - acute kidney injury (AKI) KW - acute renal failure (ARF) KW - cardiac surgery KW - effect modification KW - estimated glomerular filtration rate (eGFR) KW - interleukin 18 (IL-18) KW - liver-type fatty acid binding protein (L-FABP) KW - perioperative AKI KW - prognosis KW - surgical complication SP - 1006 EP - 14 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 66 IS - 6 N2 - BACKGROUND: The interaction between baseline kidney function and the performance of biomarkers of acute kidney injury (AKI) on the development of AKI is unclear. STUDY DESIGN: Post hoc analysis of prospective cohort study. SETTING & PARTICIPANTS: The 1,219 TRIBE-AKI Consortium adult cardiac surgery cohort participants. PREDICTOR: Unadjusted postoperative urinary biomarkers of AKI measured within 6 hours of surgery. OUTCOME: AKI was defined as AKI Network stage 1 (any AKI) or higher, as well as a doubling of serum creatinine level from the preoperative value or the need for post-operative dialysis (severe AKI). MEASUREMENTS: Stratified analyses by preoperative estimated glomerular filtration rate (eGFR) ≤ 60 versus > 60mL/min/1.73m(2). RESULTS: 180 (42%) patients with preoperative eGFRs≤60mL/min/1.73m(2) developed clinical AKI compared with 246 (31%) of those with eGFRs>60mL/min/1.73m(2) (P<0.001). For log2-transformed biomarker concentrations, there was a significant interaction between any AKI and baseline eGFR for interleukin 18 (P=0.007) and borderline significance for liver-type fatty acid binding protein (P=0.06). For all biomarkers, the adjusted relative risk (RR) point estimates for the risk for any AKI were higher in those with elevated baseline eGFRs compared with those with eGFRs≤60mL/min/1.73m(2). However, the difference in magnitude of these risks was low (adjusted RRs were 1.04 [95% CI, 0.99-1.09] and 1.11 [95% CI, 1.07-1.15] for those with preoperative eGFRs≤60mL/min/1.73m(2) and those with higher eGFRs, respectively). Although no biomarker displayed an interaction for baseline eGFR and severe AKI, log2-transformed interleukin 18 and kidney injury molecule 1 had significant adjusted RRs for severe AKI in those with and without baseline eGFRs≤60mL/min/1.73m(2). LIMITATIONS: Limited numbers of patients with severe AKI and post-operative dialysis. CONCLUSIONS: The association between early postoperative AKI urinary biomarkers and AKI is modified by preoperative eGFR. The degree of this modification and its impact on the biomarker-AKI association is small across biomarkers. Our findings suggest that distinct biomarker cutoffs for those with and without a preoperative eGFR≤60mL/min/1.73m(2) is not necessary. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/26386737/Urine_Biomarkers_and_Perioperative_Acute_Kidney_Injury:_The_Impact_of_Preoperative_Estimated_GFR_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(15)01063-X DB - PRIME DP - Unbound Medicine ER -