Long-term Risk of CKD in Children Surviving Episodes of Acute Kidney Injury in the Intensive Care Unit: A Prospective Cohort Study

ObjectivesTo test the methodology of recruitment, retention and data completeness in a prospective cohort recruited after a hospitalised episode of acute kidney injury (AKI), to inform a future prospective cohort study examining the effect of obesity on AKI outcomes.DesignFeasibility study.SettingSingle centre, multi-site UK tertiary hospital.Participants101 participants (67M; 34F) with a median age of 64 (IQR 53–73) years, with and without obesity, recruited within 3 months of a hospitalised episode of AKI.Outcome measuresFeasibility outcomes were recruitment (>15% meeting inclusion criteria recruited), participant retention at 6 and 12 months (≥80%) and completeness of data collection. Exploratory measures included recovery from AKI (regaining >75% of pre-AKI estimated glomerular filtration rate [eGFR]) at 6 months, development or progression of chronic kidney disease (CKD) (kidney function decrease of ≥25% + rise in CKD category) at 12 months, and associations with poorer kidney outcomes.Results41% of eligible patients consented to take part, exceeding the target recruitment uptake rate of 15%. Retention was 86% at 6 months and 78% at 12 months; 10 patients died and three commenced dialysis during the study. Data were 90%–100% complete. Median BMI was 27.9 kg/m2 (range 18.1 kg/m2–54.3 kg/m2). 50% of the cohort had stage 3 AKI and 49% had pre-existing CKD. 46% of the cohort met the AKI recovery definition at 6 months. At 12 months, 20/51 patients developed CKD (39%) and CKD progression occurred in 11/49 patients (22%). Post-AKI interleukin-6 and cystatin-C were associated with 12 months decline in eGFR.ConclusionsFeasibility to conduct a long-term observational study addressing AKI outcomes associated with obesity was demonstrated. A fully powered prospective cohort study to examine the relationships between obesity and outcomes of AKI is warranted.

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Faculty Opinions recommendation of Novel and conventional serum biomarkers predicting acute kidney injury in adult cardiac surgery--a prospective cohort study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1160130.620419 ◽

2009 ◽

Author(s):

Jay Koyner

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Kidney Injury ◽

Serum Biomarkers ◽

Adult Cardiac Surgery

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Urinary exosomal CD26 is associated with recovery from acute kidney injury in intensive care units: a prospective cohort study

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2021-0040 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Juan Du ◽

Yihui Li ◽

Qiang Sun ◽

Zhihao Wang ◽

Feng Wang ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Kidney Injury ◽

Prediction Performance ◽

Control Cohort ◽

Clinical Factors ◽

Qilu Hospital ◽

Major Adverse Kidney Events

Abstract Objectives Currently there is no validated method to predict renal reversal and recovery after acute kidney injury (AKI). As exosomes have the potential for AKI prognosis and CD26 is involved in the mechanisms in AKI, this study aims to investigate whether urinary exosomal CD26 is associated with renal-related outcomes and explore its prospect as a novel prognosis biomarker. Methods This was a single-center, prospective cohort study. A total of 133 AKI patients and 68 non-AKI patients admitted to ICU in Qilu Hospital Shandong University from January 2017 to January 2018. Urine samples were collected at enrollment and the relative expression of CD26 (CD26 percentage) in urinary exosomes was examined, that was then categorized into a low-CD26 level and a high-CD26 level. Results CD26 percentage was significantly lower in the AKI cohort than in the control cohort. Within the AKI cohort, a high-CD26 level was associated with lower incidence of major adverse kidney events within 90 days, but higher incidence of reversal within 28 days. In AKI survivors, a high-CD26 level had a 4.67-, 3.50- and 4.66-fold higher odds than a low-CD26 level for early reversal, recovery and reversal, respectively, after adjustment for clinical factors. Prediction performance was moderate for AKI survivors but improved for non-septic AKI survivors. Conclusions Urinary exosomal CD26 is associated with renal reversal and recovery from AKI and is thus a promising prognosis biomarker.

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