Urinary kidney injury molecule-1 as an early indicator to predict contrast-induced acute kidney injury in patients with diabetes mellitus undergoing percutaneous coronary intervention

Abstract

Abstract. With the improvement of the skill level of coronary intervention, contrast agents are used more widely. As a result, contrast-induced acute kidney injury (CI-AKI) is currently the third leading cause of hospital-acquired AKI. Traditionally, AKI is defined by measuring an increase of the serum creatinine concentration (Scr). CI-AKI indicates impairment in renal function, which is diagnosed as an elevation in the SCr levels following intravascular injection of the contrast media. However, Scr is an insensitive indicator for detecting CI-AKI. The present study was designed to investigate whether human urinary kidney injury molecule-1 (KIM-1) is an early marker to predict CI-AKI in patients with diabetes mellitus undergoing percutaneous coronary intervention (PCI). The present study includes the general clinical data of 145 patients with diabetes mellitus who underwent PCI between March 1, 2013 and December 31, 2013. A non-ionic, low osmolarity contrast agent was used during the present study. The Scr levels and estimated glomerular filtration rate were measured prior to and within 24 and 48 h after the injection of contrast agents. Urinary samples were collected prior to and within 2, 6, 12, 24 and 48 h after the coronary interventional procedure. Simultaneously, the urinary KIM-1 values were measured using an ELISA kit. CI-AKI was diagnosed as an increase of ≥0.5 mg/dl or ≥25% in Scr concentration over baseline, 24-48 h after the procedure. In total, 19 of 145 (13.1%) patients exhibited CI-AKI. There was a significant difference (P<0.05) between the urinary KIM-1 levels measured 2, 6, 12, 24 and 48 h after the procedure and those prior to the procedure in the CI-AKI group. There was no significant difference between the Scr values measured 24 h after the procedure and those prior to the procedure. Evidently, using KIM-1 values to predict CI-AKI was <24 h earlier compared to using Scr values. The area under the receiver operating characteristic curve of KIM-1 24 h after the procedure was 0.856 and the 95% confidence interval of the corresponding area was 0.782-0.929. When the pivotal point of CI-AKI diagnosis was 6,327.755 pg/ml, the specificity was 85.7% and the sensitivity was 73.7%. Univariate analysis showed that the Scr concentration was positively correlated with the urinary KIM-1 level during the time prior to the procedure and 24 and 48 h after the procedure. In conclusion, the urinary KIM-1 may be a potential indicator for the early diagnosis of CI-AKI.

Neutrophil gelatinase-associated lipocalin (NGAL) predicts the occurrence of malaria-induced acute kidney injury

“…Urinary KIM-1 concentrations were found to increase much earlier than blood urea nitrogen and plasma creatinine in studies in which proximal tubule injury was induced by cadmium or ischemia [ 8 , 17 , 18 ]. Its performance as an early marker for AKI has been evaluated in several clinical settings, including contrast-induced nephropathy [ 19 – 21 ] and sepsis [ 20 ], but not during malaria.…”

Early Predictors of Acute Kidney Injury: A Narrative Review

“…The Scr concentration was positively correlated with the urinary KIM-1 level during the time prior to the procedure and 24 and 48 h after the procedure. Urinary KIM-1 may be a potential indicator for the early diagnosis of CI-AKI [35].…”

Prediction of contrast‐induced acute kidney injury by early post‐procedural analysis of urinary biomarkers and intra‐renal Doppler flow indices in patients undergoing coronary angiography

“…It was proven in the study by Torregrosa et al that urinary IL‐18 assessed at 12 h was predictive of further renal function decline (AUC = 0.71) and performed better than urinary L‐FABP (AUC = 0.74), but worse than urinary NGAL (AUC = 0.96). Also, urinary KIM‐1 exhibited an even better diagnostic utility according to study by Li et al (AUC = 0.86), but when assessed at 24 h following the procedure. Urinary KIM‐1 level was also associated with the need for dialysis and chronic kidney disease development …”