@article{e27a8f93639f4113a80cef806203e893,
title = "Kidney Tubular Damage and Functional Biomarkers in Acute Kidney Injury Following Cardiac Surgery",
abstract = "Background: Cardiac surgery–associated acute kidney injury (AKI) is associated with increased morbidity and mortality. We examined the utility of combining biomarkers of kidney function loss (serum cystatin C) and kidney tubular damage (urine neutrophil gelatinase-associated lipocalin [NGAL] and Kidney Injury Molecule-1 [KIM-1]) for the prediction of post–cardiac surgery AKI. Methods: Single-center prospective cohort study of 106 adults undergoing coronary artery bypass grafting and/or valve surgery with cardiopulmonary bypass (CPB). Primary outcome was postoperative in-hospital AKI defined by serum creatinine (SCr)–Kidney Disease: Improving Global Outcomes criteria. Biomarkers were measured preoperatively, 6 hours after CPB and on postoperative days (PODs) 1 to 4. Results: A total of 23 subjects (21.7%) developed AKI. After adjusting for preoperative left ventricular ejection fraction, body mass index >30 kg/m2, and estimated glomerular filtration rate (eGFR) <60 ml/min per 1.73 m2, the combination of peak serum cystatin C and peak urine KIM-1/creatinine (Cr) (6 hours post-CPB to POD 1) above optimal cutoff significantly associated with postoperative AKI (odds ratio [OR]: 5.32; 95% confidence interval [CI]: 1.31–21.67; P = 0.020). This biomarker combination significantly improved the performance of the clinical model for the prediction of postoperative AKI (area under the curve [AUC]: 0.77, 95% CI: 0.65–0.90 for the clinical model alone versus 0.83, 95% CI: 0.73–0.93 for the clinical model with the addition of biomarker data, P = 0.049). Conclusions: Combining biomarkers of postoperative kidney function loss and postoperative kidney tubular damage significantly improved prediction of in-hospital AKI following cardiac surgery. Future large, multicenter studies are warranted to assess whether panels of biomarkers reflecting distinct pathobiology can be used to guide interventions and improve short- and long-term outcomes in patients undergoing cardiac surgery.",
keywords = "acute kidney injury, biomarkers, critical care, major adverse kidney events, prediction, thoracic surgery",
author = "Neyra, {Javier A.} and Hu, {Ming Chang} and Abu Minhajuddin and Nelson, {Geoffrey E.} and Ahsan, {Syed A.} and Toto, {Robert D.} and Jessen, {Michael E.} and Moe, {Orson W.} and Fox, {Amanda A.}",
note = "Funding Information: This study was supported by the Department of Anesthesiology and Pain Management of UT Southwestern Medical Center (to AAF), NIH NIDDK P30DK079328, UT Southwestern O{\textquoteright}Brien Kidney Center (to OWM, and AAF awarded a Pilot and Feasibility Grant from this funding source), and NIDDK R01 DK092461–04S1 (to JAN, M-CH, OWM, and AAF) JAN was supported by the Ben J. Lipps Research Fellowship Program of American Society of Nephrology Foundation for Kidney Research and the UT Southwestern Truelson Fellowship Fund from the Jane Pak Center of Mineral Metabolism and Clinical Research. JAN is currently supported by an Early Career Pilot Grant from the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant UL1TR001998. Funding Information: The authors thank Lauren Wehrmann, BS; Alberto Portillo, MS; and Kenni Landgraff, RN, for their work within the study program. We thank Jia Hwei Ng, MD for preparing the graphical abstract for this manuscript. This study was supported by the Department of Anesthesiology and Pain Management of UT Southwestern Medical Center (to AAF), NIH NIDDK P30DK079328, UT Southwestern O'Brien Kidney Center (to OWM, and AAF awarded a Pilot and Feasibility Grant from this funding source), and NIDDK R01 DK092461–04S1 (to JAN, M-CH, OWM, and AAF) JAN was supported by the Ben J. Lipps Research Fellowship Program of American Society of Nephrology Foundation for Kidney Research and the UT Southwestern Truelson Fellowship Fund from the Jane Pak Center of Mineral Metabolism and Clinical Research. JAN is currently supported by an Early Career Pilot Grant from the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant UL1TR001998. Substantial contribution to conception and design (JAN, M-CH, RDT, MEJ, OWM, AAF), acquisition of data (GEN, SAA), or analysis (AM) and interpretation of data (JAN, AM, RDT, OWM, AAF). Drafting the article (JAN, AAF) or revising it critically for important intellectual content (JAN, M-CH, AM, GEN, SAA, RDT, MEJ, OWM, AAF). Final approval of the version to be published (all authors). Agreement to be accountable for all aspects of the work thereby ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved (all authors). Publisher Copyright: {\textcopyright} 2019 International Society of Nephrology",
year = "2019",
month = aug,
doi = "10.1016/j.ekir.2019.05.005",
language = "English (US)",
volume = "4",
pages = "1131--1142",
journal = "Kidney International Reports",
issn = "2468-0249",
publisher = "Elsevier Inc.",
number = "8",
}