Serum Activin A Levels and Renal Outcomes After Coronary Angiography

Abstract

prevention for contrast-induced nephropathy (cin) is limited by the lack of a single predictor. As activin A is upregulated in heart failure and chronic kidney disease, we aimed to clarify the association between activin A levels and renal outcomes after coronary angiography (CAG). This prospective observational study included 267 patients who received CAG between 2009 and 2015. CIN was defined as elevation of serum creatinine to >0.5 mg/dL or to >25% above baseline within 48 hours after CAG. During follow-up, laboratory parameters were measured every 3-6 months. Renal decline was defined as>2-fold increase in serum creatinine or initiation of dialysis. The patients were stratified into tertiles according to serum activin A levels at baseline. High activin A tertile was significantly associated more CIN and renal function decline compared to low activin A tertile (all p < 0.001). After adjusting potential confounding factors, high serum activin A tertiles was associated to CIN (Odds ratio 4.49, 95% CI 1.07-18.86, p = 0.040) and renal function decline (Hazard ratio 4.49, 95% CI 1.27-11.41, p = 0.017) after CAG. Contrast-induced nephropathy (CIN) refers to acute kidney injury (AKI) caused by the contrast medium administered for angiographic procedures, which is one of the major causes of in-hospital AKI 1. Although CIN is generally transient and reversible, it remains an important clinical issue due to its high incidence and association with adverse outcomes. Previous studies showed that CIN affects 7-25% of patients receiving angiographic procedures 2,3. Moreover, CIN increases hospitalization duration, medical costs, long-term morbidity, and mortality 4-7. The clinical significance of CIN is further supported by the fact that even mild elevation of serum creatinine levels after administration of contrast medium is associated with progressive renal decline and development of end-stage renal disease (ESRD) 8. While it has been accepted that the prevention of CIN is essentially important, the available strategies for treating established CIN remain conservative and limited to fluid and electrolyte management 9. Currently, CIN preventive measures start with risk stratification, which involves non-modifiable fixed risk factors, including preexisting chronic kidney disease (CKD), diabetes mellitus, congestive heart failure (CHF), advanced age, female sex, and modifiable risk factors, including hypotension, anemia, concurrent use of nephrotoxic drugs, hypercholesterolemia, dehydration, hyperglycemia, and the type and volume of contrast medium used 10. For patients at low risk, oral or intravenous hydration are appropriate preventive measures. On the other hand, for patients at intermediate or high risk, correction of the modifiable risk factors should be considered, which include intravenous crystalloid fluid, N-acetylcysteine, ascorbic acid, and statins 10,11. While the preventive strategy of CIN depends on risk stratification, a single and reliable predictor of CIN remains absent to date. Activin A is a secreted cytok...

Myostatin and Activin A as Biomarkers of Sarcopenia in Inflammatory Bowel Disease Patients

“…There are papers demonstrating the relationship between elevated Act A levels and the occurrence of cardiovascular and metabolic diseases [ 75 , 76 , 77 , 78 , 79 , 80 ]. A study by Kuo et al showed higher Act A levels in patients with type 2 diabetes and pre-diabetic conditions, compared to healthy subjects.…”

“…The authors found that high serum Act A levels were associated with a higher incidence of cardiovascular diseases in these patients [ 75 ]. A study by Tsai et al showed that high serum levels of Act A are associated with a higher risk of the long-term progressive deterioration of renal function in patients after coronary angiography [ 76 ]. A study in a group of patients with heart failure reported elevated levels of Act A, concluding that high levels of Act A may contribute to the pathogenesis of myocardial remodeling [ 77 ].…”