Combination of Urinary Biomarkers Improves Early Detection of Acute Kidney Injury in Patients With Heart Failure

Yang, Chia‐Hung; Chang, Chih‐Hsiang; Chen, Tien-Hsing; Fan, Pei‐Chun; Chang, Su-Wei; Chen, Chun‐Chi; Chu, Pao‐Hsien; Chen, Yi-Ting; Yang, Huang‐Yu; Yang, Chih-Wei; Chen, Yung‐Chang

doi:10.1253/circj.cj-15-0886

Cited by 40 publications

(37 citation statements)

References 42 publications

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“…Furthermore, patients may be monitored with biomarkers of AKI for early diagnosis of the condition. 48 Several protective interventions that are associated with improved clinical outcomes can be performed. Hemodialysis may be initiated early 49 or pharmacologic interventions that may protect renal function can be considered.…”

Section: Discussionmentioning

confidence: 99%

Association Between Elevated Echocardiographic Index of Left Ventricular Filling Pressure and Acute Kidney Injury After Off-Pump Coronary Artery Surgery

Hur

Nam

et al. 2018

Circ J

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and mortality. 4,9 Hemodynamic disturbance during OPCAB has been reported to have a biventricular contribution, and the major cause is believed to be diastolic dysfunction and abnormal filling of both ventricles. 10,11 As such, it is possible that an underlying increased LVFP may aggravate the intraoperative hemodynamic disturbance, resulting in a higher rate of postoperative AKI. Although previous studies have reported the effect of diastolic dysfunction on postoperative outcomes, including death or major adverse cardiac events (MACE), 4,12 postoperative renal dysfunction was evaluated only as a secondary outcome and the association between increased LVFP in patients with normal LV systolic function and postoperative AKI has not been fully evaluated.The ratio of the early transmitral blood flow velocity to early diastolic velocity of the mitral annulus (E/e′) has been reported to have good predictive power for mean LV diastolic pressure or mean LVFP and has been used to estimate the diastolic function of the heart. 13,14 E/e′ >15 is P erioperative acute kidney injury (AKI) has been reported to be an important contributor to postoperative morbidity and mortality especially after cardiovascular surgery, including coronary artery bypass graft (CABG). 1,2 Off-pump coronary artery bypass surgery (OPCAB) has been associated with less severe and a lower incidence of AKI compared with on-pump CABG. 3 Nonetheless, there is still a substantial incidence of AKI after OPCAB and it is caused by transient circulatory arrest, global hypoperfusion, myocardial ischemia-reperfusion injury, and inflammatory response. 3 The incidence of diastolic dysfunction in patients who undergo CABG has been reported as high. 4,5 Although many studies have reported systolic dysfunction of the heart as a risk factor for postoperative AKI, 6,7 the association between preoperative diastolic dysfunction and postoperative AKI has not been investigated. A stiff left ventricle with low compliance would lead to an elevated LV filling pressure (LVFP), 8 which is associated with higher morbidity Background: The ratio of the early transmitral flow velocity to early diastolic velocity of the mitral annulus (E/e′) is an echocardiographic index of mean left ventricular (LV) filling pressure. We investigated the association between the preoperative E/e′ ratio and postoperative acute kidney injury (AKI) during off-pump coronary artery bypass surgery (OPCAB).

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Section: Discussionmentioning

confidence: 99%

Association Between Elevated Echocardiographic Index of Left Ventricular Filling Pressure and Acute Kidney Injury After Off-Pump Coronary Artery Surgery

Hur

Nam

et al. 2018

Circ J

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show abstract

“…A previous prospective study by Chen, et al has also shown that AKI occurred in 28.7% of patients who were admitted to the CCU due to acute myocardial infarction [10]. Nevertheless, in patients with ADHF, Yang et al have shown that the incidence of AKI further increased to 47.6%[30]. This higher incidence of AKI in ADHF patients has been referred to as acute cardiac and renal dysfunction [31-34].…”

Section: Discussionmentioning

confidence: 99%

Serum Cystatin C Predicts AKI and the Prognosis of Patients in Coronary Care Unit: a Prospective, Observational Study

Hu¹,

Liu²,

Du³

et al. 2017

Kidney Blood Press Res

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Background/Aims: Acute Kidney Injury (AKI) is a serious clinical state associated with high morbidity and mortality, particularly in critical ill patients. We investigated the hypothesis that serum Cystatin C (sCysC) is a good predictor for AKI and may affect the short-term prognosis of coronary care unit (CCU) patients. Methods: In this prospective, observational study, we screened 412 adults admitted to the CCU from January 1, 2014 to June 1, 2015 at Zhongnan Hospital of Wuhan University. Serum samples were obtained at the time of admission, and sCysC was quantified through nephelometry. AKI was defined based on KDIGO-AKI criteria. After the patients’ hospital discharge, the survivors in this study were followed up for up to 2 years. The primary endpoint was the incidence of AKI stratified by severity stage, while the second endpoints included 2-year mortality, rehospitalization and failure in renal recovery rates, as well as the progression of AKI to CKD. Results: According to the KDIGO-AKI criteria, AKI occurred in 130 (31.6%) patients. After multivariate adjustments, the highest quartile of sCysC was associated with a 9-fold increased risk of incident AKI compared with the lowest quartile. For predicting AKI, sCysC [area under the receiver operating characteristic curve (AUC=0.842)] outperformed β2-micro globulin (AUC=0.813) and the clinical model (AUC=0.777), and a cutoff of 1.255 mg/L yielded good sensitivity and specificity. After a median 19.8-month follow-up, 112 (27.2%) patients died within 2 years after admission. The sCysC independently predicted the risk of 2-year mortality [adjusted odds ratio (OR), 4.955; 95% confidence interval (95% CI), 2.853 to 8.603] and rehospitalization (OR, 3.128; 95% CI, 2.011 to 4.867), as well as renal recovery failure (OR, 3.618, 95% CI, 1.753 to 7.463). Conclusions: Serum CysC is a strong predictor of AKI and the short-term prognosis of CCU patients.

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“…In these studies, the average sensitivity and specificity of NGAL measured one to three days prior to AKI diagnosis was 76 and 77 percent respectively, for cardiac surgery patients, and 73 and 80 percent respectively, for patients admitted to the ICU. [5] In a prospective study of patients undergoing cardiac surgery, each of the biomarkers urine cystatin C, NGAL, KIM-1, alpha glutathione S-transferases (α-GST), and pi-GST demonstrated the ability to diagnose stage 3 AKI at various postoperative time points. [6] Preoperative KIM-1 and alpha-GST predicted the development of stage 1 and stage 3 AKI.…”

Section: The Role Of Biomarkers In Early Diagnosis Of Akimentioning

confidence: 99%

The biomarkers for acute kidney injury: A clear road ahead?

Peng

2016

Journal of Translational Internal Medicine

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Combination of Urinary Biomarkers Improves Early Detection of Acute Kidney Injury in Patients With Heart Failure

Cited by 40 publications

References 42 publications

Association Between Elevated Echocardiographic Index of Left Ventricular Filling Pressure and Acute Kidney Injury After Off-Pump Coronary Artery Surgery

Association Between Elevated Echocardiographic Index of Left Ventricular Filling Pressure and Acute Kidney Injury After Off-Pump Coronary Artery Surgery

Serum Cystatin C Predicts AKI and the Prognosis of Patients in Coronary Care Unit: a Prospective, Observational Study

The biomarkers for acute kidney injury: A clear road ahead?

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