Association of Definition of Acute Kidney Injury by Cystatin C Rise With Biomarkers and Clinical Outcomes in Children Undergoing Cardiac Surgery

Background and purpose Acute Kidney Injury (AKI) is a severe complication affecting many hospitalized patients after cardiac surgery, with negative impacts on short- and long-term clinical outcomes and on healthcare costs. Recently, clinical interest has been aimed at defining and classifying AKI, identifying risk factors and developing diagnostic strategies to identify patients at risk early on. Achieving an early and accurate diagnosis of AKI is a crucial issue, because prevention and timely detection may help to prevent negative clinical outcomes and avoid AKI-associated costs. In this retrospective study, we evaluate the NephroCheck Test as a diagnostic tool for early detection of AKI in a high-risk population of patients undergoing cardiac surgery at the San Bortolo Hospital of Vicenza. Methods We assessed the ability of the NephroCheck Test to predict the probability of developing CSA-AKI (cardiac surgery-associated AKI) and evaluated its accuracy as a diagnostic test, by building a multivariate logistic regression model for CSA-AKI prediction. Results Based on our findings, when the results of the NephroCheck Test are included in a multivariate model its performance is substantially improved, as compared to the benchmark model, which only accounts for the other clinical factors. We also define a rule – in terms of a probability cut-off – for discriminating cases that are at higher risk of developing AKI of any stage versus those in which AKI is less likely. Conclusions Our study has implications in clinical practice: when a Nephrocheck Test result is >0.3 ng/dL, an automated electronic alert prompts the physician to intervene by following a checklist of preventive measures.

Download Full-text

Cystatin C and neutrophil gelatinase-associated lipocalin (NGAL) as novel biomarkers for monitoring acute kidney injury after cardiac surgery

Journal of Cardiothoracic Surgery ◽

10.1186/1749-8090-8-s1-o259 ◽

2013 ◽

Vol 8 (S1) ◽

Author(s):

JM Kalisnik ◽

A Hrastovec ◽

M Skitek ◽

A Jerin ◽

B Gersak

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Cystatin C ◽

Kidney Injury ◽

Neutrophil Gelatinase Associated Lipocalin ◽

Novel Biomarkers ◽

Neutrophil Gelatinase

Download Full-text

Serum Cystatin C as a predictor of cardiac surgery associated-acute kidney injury in patients with normal preoperative renal functions. A prospective cohort study

The Egyptian Journal of Critical Care Medicine ◽

10.1016/j.ejccm.2017.02.002 ◽

2017 ◽

Vol 5 (1) ◽

pp. 41-47

Author(s):

Mohamed Samy ◽

Tamer S. Fahmy ◽

Hasan Effat ◽

Alaa Ashour

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Cohort Study ◽

Prospective Cohort Study ◽

Cystatin C ◽

Prospective Cohort ◽

Kidney Injury ◽

Serum Cystatin C ◽

Serum Cystatin ◽

Renal Functions

Download Full-text

Association between mineral and bone disorder in patients with acute kidney injury following cardiac surgery and adverse outcomes

BMC Nephrology ◽

10.1186/s12882-019-1572-y ◽

2019 ◽

Vol 20 (1) ◽

Author(s):

Tianye Yang ◽

Wenji Wang ◽

Xiao Tang ◽

Peng Shi ◽

Lulu Zhang ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Clinical Outcomes ◽

Fibroblast Growth Factor 23 ◽

Kidney Injury ◽

Adverse Outcomes ◽

Tartrate Resistant Acid Phosphatase ◽

Mineral And Bone Disorder ◽

Bone Specific Alkaline Phosphatase ◽

Increased Risk

Abstract Background Numerous studies have evaluated the prevalence and importance of mineral and bone disorders among patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). However, little is known about dysregulated mineral and bone metabolism in acute kidney injury (AKI). Methods We evaluated the association between mineral and bone metabolites and clinical outcomes in 158 patients who underwent cardiac surgery and developed AKI between June 2014 and January 2016. The baseline characteristics of the patients were recorded, and the levels of mineral and bone metabolites, including calcium, phosphate, intact parathyroid hormone (iPTH), 25-hydroxyvitamin D (25D), bone-specific alkaline phosphatase (BAP), tartrate-resistant acid phosphatase 5b (TRACP-5b) and C-terminal fibroblast growth factor 23 (cFGF23) were measured within 12 h after establishing the clinical diagnosis. Results The serum phosphate, iPTH and cFGF23 levels were significantly associated with the 28-day mortality (phosphate: Hazard Ratio [HR] =2.620, 95% CI: 1.083 to 6.338, p = 0.035; iPTH: HR = 1.044, 95% CI: 1.001 to 1.090, p = 0.046; cFGF23: HR = 1.367, 95% CI: 1.168 to 1.599, p < 0.001). Moreover, higher serum cFGF23 and BAP levels were independently associated with an increased risk of adverse outcomes. Additionally, we found that the serum cFGF23 levels rose most significantly and were associated with the severity of AKI (P < 0.001). Conclusions Mineral and bone metabolites are dysregulated and are associated with adverse clinical outcomes among patients with AKI. Trial registration www.clinicaltrials.gov NCT 00953992. Registered 6 August 2009.

Download Full-text