Routine Adoption of TIMP2 and IGFBP7 Biomarkers in Cardiac Surgery for Early Identification of Acute Kidney Injury

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

Novel Urinary Biomarkers for Acute Kidney Injury and Prediction of Clinical Outcomes After Pediatric Cardiac Surgery

Pediatric Cardiology ◽

10.1007/s00246-019-02280-3 ◽

2019 ◽

Vol 41 (4) ◽

pp. 695-702 ◽

Cited By ~ 5

Author(s):

Fumiya Yoneyama ◽

Toru Okamura ◽

Kiyohiro Takigiku ◽

Satoshi Yasukouchi

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Clinical Outcomes ◽

Kidney Injury ◽

Pediatric Cardiac Surgery ◽

Urinary Biomarkers

Download Full-text

Stratifying risk of acute kidney injury in pre and post cardiac surgery patients using a novel biomarker-based algorithm and clinical risk score

Scientific Reports ◽

10.1038/s41598-019-53349-1 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 3

Author(s):

William T. McBride ◽

Mary Jo Kurth ◽

Gavin McLean ◽

Anna Domanska ◽

John V. Lamont ◽

...

Keyword(s):

At Risk ◽

Acute Kidney Injury ◽

Cardiac Surgery ◽

Risk Score ◽

Kidney Injury ◽

Predictive Ability ◽

Clinical Risk Score ◽

Clinical Risk ◽

Patients At Risk ◽

Post Cardiac Surgery

AbstractAcute kidney injury (AKI) following cardiac surgery significantly increases morbidity and mortality risks. Improving existing clinical methods of identifying patients at risk of perioperative AKI may advance management and treatment options. This study investigated whether a combination of biomarkers and clinical factors pre and post cardiac surgery could stratify patients at risk of developing AKI. Patients (n = 401) consecutively scheduled for elective cardiac surgery were prospectively studied. Clinical data was recorded and blood samples were tested for 31 biomarkers. Areas under receiver operating characteristic (AUROCs) were generated for biomarkers pre and postoperatively to stratify patients at risk of AKI. Preoperatively sTNFR1 had the highest predictive ability to identify risk of developing AKI postoperatively (AUROC 0.748). Postoperatively a combination of H-FABP, midkine and sTNFR2 had the highest predictive ability to identify AKI risk (AUROC 0.836). Preoperative clinical risk factors included patient age, body mass index and diabetes. Perioperative factors included cardio pulmonary bypass, cross-clamp and operation times, intra-aortic balloon pump, blood products and resternotomy. Combining biomarker risk score (BRS) with clinical risk score (CRS) enabled pre and postoperative assignment of patients to AKI risk categories. Combining BRS with CRS will allow better management of cardiac patients at risk of developing AKI.

Download Full-text

CSA-AKI: Incidence, Epidemiology, Clinical Outcomes, and Economic Impact

Journal of Clinical Medicine ◽

10.3390/jcm10245746 ◽

2021 ◽

Vol 10 (24) ◽

pp. 5746

Author(s):

Alan Schurle ◽

Jay L. Koyner

Keyword(s):

Cardiac Surgery ◽

Patient Outcomes ◽

Kidney Injury ◽

High Risk Population ◽

Evidence Based ◽

Evidence Based Treatment ◽

Icu Length Of Stay ◽

Patients At Risk ◽

The Cost ◽

Hospital Rehabilitation

Cardiac surgery-associated acute kidney injury (CSA-AKI) is a common complication following cardiac surgery and reflects a complex biological combination of patient pathology, perioperative stress, and medical management. Current diagnostic criteria, though increasingly standardized, are predicated on loss of renal function (as measured by functional biomarkers of the kidney). The addition of new diagnostic injury biomarkers to clinical practice has shown promise in identifying patients at risk of renal injury earlier in their course. The accurate and timely identification of a high-risk population may allow for bundled interventions to prevent the development of CSA-AKI, but further validation of these interventions is necessary. Once the diagnosis of CSA-AKI is established, evidence-based treatment is limited to supportive care. The cost of CSA-AKI is difficult to accurately estimate, given the diverse ways in which it impacts patient outcomes, from ICU length of stay to post-hospital rehabilitation to progression to CKD and ESRD. However, with the global rise in cardiac surgery volume, these costs are large and growing.

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

Reduction in acute kidney injury post cardiac surgery using balanced forced diuresis: a randomized, controlled trial

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezaa395 ◽

2020 ◽

Author(s):

Heyman Luckraz ◽

Ramesh Giri ◽

Benjamin Wrigley ◽

Kumaresan Nagarajan ◽

Eshan Senanayake ◽

...

Keyword(s):

At Risk ◽

Acute Kidney Injury ◽

Cardiac Surgery ◽

Confidence Interval ◽

Kidney Injury ◽

Control Group ◽

Binary Logistic Regression Analysis ◽

Number Needed To Treat ◽

Forced Diuresis ◽

Patients At Risk

Abstract OBJECTIVES Our goal was to investigate the efficacy of balanced forced diuresis in reducing the rate of acute kidney injury (AKI) in cardiac surgical patients requiring cardiopulmonary bypass (CPB), using the RenalGuard® (RG) system. METHODS Patients at risk of developing AKI (history of diabetes and/or anaemia; estimated glomerular filtration rate 20–60 ml/min/1.73 m2; anticipated CPB time >120 min; log EuroSCORE > 5) were randomized to the RG system group (n = 110) or managed according to current practice (control = 110). The primary end point was the development of AKI within the first 3 postoperative days as defined by the RIFLE (Risk, Injury, Failure, Loss of kidney function, End-stage renal disease) criteria. RESULTS There were no significant differences in preoperative and intraoperative characteristics between the 2 groups. Postoperative AKI rates were significantly lower in the RG system group compared to the control group [10% (11/110) vs 20.9% (23/110); P = 0.025]. This effect persisted even after controlling for a number of potential confounders (odds ratio 2.82, 95% confidence interval 1.20–6.60; P = 0.017) when assessed by binary logistic regression analysis. The mean volumes of urine produced during surgery and within the first 24 h postoperatively were significantly higher in the RG system group (P < 0.001). There were no significant differences in the incidence of blood transfusions, atrial fibrillation and infections and in the median duration of intensive care unit stays between the groups. The number needed to treat with the RG system to prevent AKI was 9 patients (95% confidence interval 6.0–19.2). CONCLUSIONS In patients at risk for AKI who had cardiac surgery with CPB, the RS RG system significantly reduced the incidence of AKI and can be used safely and reproducibly. Larger studies are required to confirm cost benefits. Clinical trial registration number: NCT02974946

Download Full-text

Brain and Muscle Oxygen Saturation Combined with Kidney Injury Biomarkers Predict Cardiac Surgery Related Acute Kidney Injury

Diagnostics ◽

10.3390/diagnostics11091591 ◽

2021 ◽

Vol 11 (9) ◽

pp. 1591

Author(s):

Wiktor Szymanowicz ◽

Ludmiła Daniłowicz-Szymanowicz ◽

Wojtek Karolak ◽

Maciej Michał Kowalik ◽

Romuald Lango

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Oxygen Saturation ◽

Cystatin C ◽

Near Infrared ◽

Kidney Injury ◽

Tissue Oxygen Saturation ◽

Muscle Oxygen ◽

Patients At Risk ◽

Novel Biomarkers

Background: Early identification of patients at risk for cardiac surgery-associated acute kidney injury (CS-AKI) based on novel biomarkers and tissue oxygen saturation might enable intervention to reduce kidney injury. Aims: The study aimed to ascertain whether brain and muscle oxygenation measured by near-infrared spectroscopy (NIRS), in addition to cystatin C and NGAL concentrations, could help with CS-AKI prediction. Methods: This is a single-centre prospective observational study on adult patients undergoing cardiac surgery using cardiopulmonary bypass (CPB). Brain and muscle NIRS were recorded during surgery. Cystatin C was measured on the first postoperative day, while NGAL directly before and 3 h after surgery. Results: CS-AKI was diagnosed in 18 (16%) of 114 patients. NIRS values recorded 20 min after CPB (with cut-off value ≤ 54.5% for muscle and ≤ 62.5% for the brain) were revealed to be the most accurate predictors of CS-AKI. Preoperative NGAL ≥ 91.5 ng/mL, postoperative NGAL ≥ 140.5 ng/mL, and postoperative cystatin C ≥ 1.23 mg/L were identified as independent and significant CS-AKI predictors. Conclusions: Brain and muscle oxygen saturation 20 min after CPB could be considered early parameters possibly related to CS-AKI risk, especially in patients with increased cystatin C and NGAL levels.

Download Full-text