Urinary Biomarkers Can Predict Weaning From Acute Dialysis Therapy in Critically Ill Patients

Pan, Heng‐Chih; Huang, Thomas Tao-Min; Huang, Chun-Te; Sun, Chiao‐Yin; Chen, Ming-Fong; Wu, Vin‐Cent

doi:10.5858/arpa.2021-0411-oa

Cited by 17 publications

(13 citation statements)

References 61 publications

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“…While this approach may not accurately capture the ongoing progression of AKI or incomplete renal recovery after AKI, recent research from the same database suggests that our approach likely had a low risk of bias ( 42 ). Nevertheless, subclinical AKI may be missed due to a lack of biomarkers other than sCr in the database ( 43 – 45 ). Third, community-acquired AKI may have been misdiagnosed as chronic kidney disease (CKD) due to our use of sCr data collected during admission, which could have led to an underestimation of the true incidence of AKI.…”

Section: Discussionmentioning

confidence: 99%

Risk factors and 180-day mortality of acute kidney disease in critically ill patients: A multi-institutional study

Pan

Chen

et al. 2023

Front. Med.

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BackgroundCritically ill patients with acute kidney injury (AKI) have a poor prognosis. Recently, the Acute Disease Quality Initiative (ADQI) proposed to define acute kidney disease (AKD) as acute or subacute damage and/or loss of kidney function post AKI. We aimed to identify the risk factors for the occurrence of AKD and to determine the predictive value of AKD for 180-day mortality in critically ill patients.MethodsWe evaluated 11,045 AKI survivors and 5,178 AKD patients without AKI, who were admitted to the intensive care unit between 1 January 2001 and 31 May 2018, from the Chang Gung Research Database in Taiwan. The primary and secondary outcomes were the occurrence of AKD and 180-day mortality.ResultsThe incidence rate of AKD among AKI patients who did not receive dialysis or died within 90 days was 34.4% (3,797 of 11,045 patients). Multivariable logistic regression analysis indicated that AKI severity, underlying early CKD, chronic liver disease, malignancy, and use of emergency hemodialysis were independent risk factors of AKD, while male gender, higher lactate levels, use of ECMO, and admission to surgical ICU were negatively correlated with AKD. 180-day mortality was highest among AKD patients without AKI during hospitalization (4.4%, 227 of 5,178 patients), followed by AKI with AKD (2.3%, 88 of 3,797 patients) and AKI without AKD (1.6%, 115 of 7,133 patients). AKI with AKD had a borderline significantly increased risk of 180-day mortality (aOR 1.34, 95% CI 1.00–1.78; p = 0.047), while patients with AKD but no preceding AKI episodes had the highest risk (aOR 2.25, 95% CI 1.71–2.97; p < 0.001).ConclusionThe occurrence of AKD adds limited additional prognostic information for risk stratification of survivors among critically ill patients with AKI but could predict prognosis in survivors without prior AKI.

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Section: Discussionmentioning

confidence: 99%

Risk factors and 180-day mortality of acute kidney disease in critically ill patients: A multi-institutional study

Pan

Chen

et al. 2023

Front. Med.

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“…Neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) are markers of renal tubular injury [ 22 , 23 ], and insulin-like growth factor binding protein-2 (IGFBP-2) is also a novel marker for kidney inflammation [ 24 ]. The cytokine array results of kidney protein lysates showed that the levels of NGAL and IGFBP-2 in the kidneys of Kdm4c −/− mice were 1.5-fold higher than those of WT mice, which indicated that Kdm4c −/− mice had increased kidney inflammation after AKI compared with wild-type mice.…”

Section: Resultsmentioning

confidence: 99%

Essential Roles of the Histone Demethylase KDM4C in Renal Development and Acute Kidney Injury

Pan

Chen

Fang

et al. 2022

IJMS

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Background: Lysine demethylase 4C (KDM4C) is a nuclear protein that is essential for histone modification and acts as an important regulator of several transcription factors. Previous studies have shown that KDM4C may also play a role in mediating stress responses. The purpose of this study was to examine the roles of KDM4C in kidney development and acute kidney injury (AKI). Methods: The effect of KDM4C on kidney development was assessed by comparing the kidney phenotype between 96 zebrafish embryos treated with kdm4c-morpholino oligonucleotide and 96 untreated zebrafish embryos. We further examined whether KDM4C is essential for maintaining cell survival in AKI. Cultured human renal tubular cells were used for the in vitro study. Wild-type and Kdm4c knockout mice (C57BL/6NTac-Kdm4ctm1a(KOMP)Wtsi) were divided into a sham group and model group, and then subjected to ischemic reperfusion kidney injury (IRI-AKI). Blood samples and kidneys were collected at different time points (day 3, day 7, day 14, and day 28) and were processed for in vivo studies (n = 8 in each group). Results: Kdm4c knockdown significantly decreased zebrafish embryo survival and impaired kidney development. The in vitro study showed that KDM4C inhibition by JIB04 significantly increased cellular apoptosis under oxidative stress conditions. KDM4C knockdown cells had impaired autophagy function under stress conditions. The IRI-AKI mice study showed that KDM4C protein levels dynamically changed and were significantly correlated with HIF-1α levels in AKI. Kdm4c−/− mice had significantly more severe renal impairment and increased kidney fibrosis than the wild-type mice. Cytokine array results also indicated that the kidneys of Kdm4c−/− mice had increased inflammation in AKI compared with the wild-type mice. Further RNA sequence analysis revealed that KDM4C may regulate transcription factors related to mitochondrial dynamics and function. Conclusions: Our study suggests that KDM4C may play a critical role in regulating mitochondria, which is related to a protective effect on maintaining cell survival in AKI.

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“…Therefore, in canine FS, functional recovery of proximal tubules may be achieved even if the tissues are not completely repaired, and the degree of proximal tubular dysfunction may not necessarily be linked to the severity of tissue damage. A human report of critically ill patients with acute kidney injury demonstrated that a low urinary L-FABP level was an independent prognostic factor for weaning from renal replacement therapy ( Pan et al , 2022 ). Also, during follow-up of dogs with FS, urinary L-FABP may be a useful clinical marker to determine remission in conjunction with tubular function tests.…”

Section: Discussionmentioning

confidence: 99%

Urinary liver-type fatty acid-binding protein in two dogs with acquired Fanconi syndrome: A case report

Takashima¹,

Nasu²,

Ohata³

et al. 2022

Open Vet J

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Background: Fanconi syndrome (FS) is defined as multiple defects of the proximal tubules and is diagnosed by clinical symptoms. However, in dogs with FS, the damage in the proximal tubules that are responsible for the clinical symptoms has not been evaluated. Among FS cases, tubular damage in acquired FS is reversible following the elimination of a causative factor. Liver-type fatty acid-binding protein (L-FABP) is a biomarker of tubular damage in various animals including dogs. Urinary L-FABP measurement may be useful for the diagnosis and follow-up evaluation in canine FS. Case Description: At the first visit, two Toy Poodles that had no remarkable findings on physical examination presented with glycosuria without hyperglycemia, hypokalemia, hyperchloremia, increased levels of plasma alkaline phosphatase, and metabolic acidosis. Considering all the factors involved, the dogs were clinically diagnosed with acquired FS. The owner reported that they routinely fed the dog with chicken jerky, a recently considered cause of acquired FS. Following the withdrawal of the jerky, abnormalities including glycosuria improved in both dogs. Moreover, urinary L-FABP levels, which were high at diagnosis, presented a decreasing trend during the follow-up. However, in one dog, the elevated urinary L-FABP level did not return to normal. Conclusion: Although the clinical symptoms of acquired FS in dogs could be improved by the elimination of a causative factor, the severity of tubular damage described by urinary L-FABP may not be necessarily linked to the degree of functional deterioration. Therefore, the evaluation of proximal tubular damage by L-FABP may be of clinical value during the follow-up of acquired FS in canines.

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Urinary Biomarkers Can Predict Weaning From Acute Dialysis Therapy in Critically Ill Patients

Cited by 17 publications

References 61 publications

Risk factors and 180-day mortality of acute kidney disease in critically ill patients: A multi-institutional study

Risk factors and 180-day mortality of acute kidney disease in critically ill patients: A multi-institutional study

Essential Roles of the Histone Demethylase KDM4C in Renal Development and Acute Kidney Injury

Urinary liver-type fatty acid-binding protein in two dogs with acquired Fanconi syndrome: A case report

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