Kidney Week

Abstract: FR-PO113

Pre-Operative Plasma TNFR1, TNFR2, and KIM-1 Are Associated with AKI and One Year Mortality in Cardiac Surgery Patients

Session Information

• AKI Clinical: Outcomes and Biomarkers
  November 03, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Acute Kidney Injury

• 003 AKI: Clinical and Translational

Authors

• Coca, Steven G., Icahn School of Medicine at Mount Sinai, New York, New York, United States

Steven G. Coca,

• Moledina, Dennis G., Yale School of Medicine, New Haven, Connecticut, United States

Dennis G. Moledina,

• Jia, Yaqi, Yale School of Medicine, New Haven, Connecticut, United States

Yaqi Jia,

• Mansour, Sherry, Yale School of Medicine, New Haven, Connecticut, United States

Sherry Mansour,

• Thiessen Philbrook, Heather, Yale School of Medicine, New Haven, Connecticut, United States

Heather Thiessen Philbrook,

• Shlipak, Michael, San Francisco VA Medical Center, San Francisco, California, United States

Michael Shlipak,

• Koyner, Jay L., University of Chicago, Chicago, Illinois, United States

Jay L. Koyner,

• Garg, Amit X., London Health Sciences Centre, London, Ontario, Canada

Amit X. Garg,

• Parikh, Chirag R., Yale University and VAMC, New Haven, Connecticut, United States

Chirag R. Parikh,

Group or Team Name

• TRIBE-AKI Consortium

Background

Plasma tumor necrosis factor receptor (TNFR)1, TNFR2, and kidney injury molecule (KIM)1 provide prognostic information in ambulatory patients with diabetes for incident or progressive kidney disease. However, their utility is not well described in settings of acute kidney injury (AKI) post cardiac surgery.

Methods

In a prospective cohort study of 1444 high-risk adults undergoing cardiac surgery (CABG, valve, or both), we sought to assess the association of pre- and post-operative (peak days 1-3) concentrations of TNFR1, TNFR2, and KIM-1 with post-operative AKI (AKIN stage 1) and 1-year all-cause mortality after cardiac surgery. Plasma TNFR1, TNFR2 and KIM-1 were measured via MesoScale Discovery multiplex assay.

Results

Pre-operative concentrations of TNFR1, TNFR2, and KIM-1 were higher in those who developed post-operative AKI (n=492, 34%) and those who died (n= 68, 6.2%) by one-year. Each log-increase of pre-operative biomarker was independently associated with a 2-3 fold higher odds of both AKI and one-year mortality [Table]. TNFR1, TNFR2, and KIM-1 concentrations increased by 136, 65, and 36%, respectively, after surgery, and differed minimally by AKI status. After adjustment for pre-operative biomarker value, peak change in serum creatinine and 13 other covariates, peak post-operative levels of TNFR1 and TNFR2, but not KIM-1, were associated with one-year mortality [Table].

Conclusion

The panel of three pre-operative biomarkers, TNFR1, TNFR2, and KIM1, provided strong prognostic information about AKI and mortality in patients undergoing cardiac surgery. Post-operative concentrations of TNFR1 and TNFR2 also provided additional prognostic information for death.

Funding

• NIDDK Support