31 Aug Urinary Biomarkers Predict Progression of Acute Kidney Injury In Heart Failure
MedicalResearch.com Interview with:
Xiaobing Yang, MD
Division of Nephrology, Nanfang Hospital
Southern Medical University
MedicalResearch.com: What is the background for this study?
Response: AKI is a common complication in patients with acute decompensated heart failure (ADHF) and associated with increased death and worse clinical outcomes. Early detecting which patients are going to suffer progressive AKI or proceed to death could help physicians to plan and initiate timely managements.
We analyzed data and samples of 732 ADHF patients from a prospective, multicenter study in China. We demonstrated that kidney injury biomarkers, measured at the first time of AKI clinical diagnosis, could predict which patients were going to have AKI progression or worsening of AKI with death. Notably, three urinary biomarkers, including urinary angiotensinogen (uAGT), urinary neutrophil gelatinase-associated lipocalin (uNGAL), urinary IL-18 (uIL-18), were all able to forecast which patients with the earliest stages of AKI were most likely to suffer progressive AKI.
MedicalResearch.com: What are the main findings?
Response: After adjustment for clinical predictors, compared with the lowest tertile, the highest tertile of three urinary biomarkers remained associated with AKI progression: uAGT (odds ratio [OR], 10.8; 95%confidence interval [95%CI], 3.4 to 34.7), uNGAL (OR, 4.7; 95% CI, 1.7 to 13.4), and uIL-18 (OR, 3.6; 95% CI, 1.4 to 9.5). uAGT was the best predictor for both primary and secondary outcomes (AKI progression and worsening of AKI with death) with area under the receiver operating curve of 0.78 and 0.85. Additionally, these three biomarkers improved risk reclassification compared with the clinical risk model alone, with uAGT performing the best (category-free net reclassification improvement for primary and secondary outcomes of 0.76 [95% CI, 0.46 to 1.06] and 0.93 [95% CI, 0.50 to 1.36]; P,0.001).
In conclusion, kidney injury biomarkers measured at the first time of AKI clinical diagnosis improved risk stratification and identified AKI patients at highest risk of adverse outcomes.
MedicalResearch.com: What should readers take away from your report?
Response: Kidney injury biomarkers (uAGT, uNGAL, and uIL-18) measured at the time of AKI diagnosis could predict AKI progression and worsening of AKI with death in acute decompensated heart failure patients. uAGT was the best predictor for both outcomes. These kidney injury biomarkers, when added to the clinical risk factors, may identify a subpopulation that is at the highest risk for the most adverse outcomes.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: For now, uAGT may be considered one of the most promising biomarkers of AKI progression associated with acute decompensated heart failure. Future studies can build on this work and use these markers to improve care of ADHF, guide patient counseling, optimize management, and facilitate clinical trials for acute cardiorenal syndrome treatment.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Citation:
Chunbo Chen, Xiaobing Yang, Ying Lei, Yan Zha, Huafeng Liu, Changsheng Ma,Jianwei Tian,
Pingyan Chen, Tiecheng Yang, and Fan Fan Hou
Urinary Biomarkers at the Time of AKI Diagnosis as Predictors of Progression of AKI among Patients with Acute Cardiorenal SyndromeCJASN CJN.00910116; published ahead of print August 18, 2016,doi:10.2215/CJN.00910116
Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.
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Last Updated on August 31, 2016 by Marie Benz MD FAAD