Abstract: FR-PO115

Early Increase in Renal Injury Urinary Biomarkers Is Associated with AKI Development in Major Elective Non-Vascular Abdominal Surgeries

Session Information

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Marçal, Lia Junqueira, University of Sao Paulo Medical School, Sao Paulo, Brazil
  • Souza, Graziela Ramos barbosa de, University of Sao Paulo Medical School, Sao Paulo, Brazil
  • Costa e Silva, Veronica T., University of Sao Paulo Medical School, Sao Paulo, Brazil
  • Zanetta, Dirce M T, University of São Paulo, S Paulo, Brazil
  • Yu, Luis, University of Sao Paulo Medical School, Sao Paulo, Brazil
  • Antonangelo, Leila, University of Sao Paulo Medical School, Sao Paulo, Brazil
  • Burdmann, Emmanuel A., University of Sao Paulo Medical School, Sao Paulo, Brazil
Background

There are few data on the incidence of acute kidney injury (AKI) diagnosed by KDIGO criteria and the role of renal injury urinary biomarkers (BMs) for predicting AKI in patients (pts) submitted to major elective non-vascular abdominal surgeries (MENVAS).

Methods

A total of 171 pts submitted to MENVAS were prospectively assessed peri-operatively and from the ICU admission up to 7 d. Analyzed outcomes were AKI development, ICU and hospital length of stay (LoS) and mortality. AKI was diagnosed by serum creatinine increase or urinary output decrease (KDIGO criteria). Urine was collected 1 day before surgery (baseline), 30 min, 12 and 24 h after ICU admission. Five urinary BMs were assessed: NGAL, KIM-1, monocyte chemotactic protein 1 (MCP1), microalbuminuria (µalb) and interleukin-18 ( IL-18) by Luminex x-MAP method. Data are mean (± SD), frequency or median (first and third quartiles). Statistical significance was set at p<0.05.

Results

Overall, age was 54±16 y, 59% were female, hospital LoS was 17.0±16.6 d, ICU LoS was 3.0±1.7 d and mortality was 7%. A total of 102 pts (59.6%) developed AKI and most were KDIGO I (81.4%).
AKI pts were older (57±13 vs. 50±17 y, p=0.006), had longer hospital (20±20 vs. 12±8 d, p=0.001) and ICU LoS (3.3±2.0 vs. 2.5±0.8 d, p=0.02) and higher mortality (9.8 vs. 2.3%, NS), compared to non-AKI.
Those developing AKI KDIGO II and III had significantly higher BMs values compared to pts KDIGO I or non-AKI in all studied times (Table).

Conclusion

We found a strikingly high incidence of MENVAS-associated AKI diagnosed by KDIGO criteria in patients admitted to the ICU. AKI was associated with significantly higher ICU and hospital LoS. Those who developed more severe AKI showed significantly higher BMs in all times studied, including the preoperative period.

baseline30 minutes - ICU12h - ICU24h - ICU
 non-AKIKDIGO IKDIGO II/IIInon-AKIKDIGO IKDIGO II/IIInon-AKIKDIGO IKDIGO II/IIInon-AKIKDIGO IKDIGO II/III
MCP-1 ng/mg0.1 (0.1- 0.2)**0.1 (0.1 – 0.2)###0.4 (0.2 - 0.9)0.4 (0.2 - 1.6)*0.5 (0.3 – 1.0)#1.6 (0.8 - 5.1)0,8 (0,4 - 1,4)
*
0,6 (0,2- 1,3)
##
2,1 (1,1 - 4,1)
0.5 (0.3 - 1.5)*0.7 (0.3 - 1.7)#1.7 (0,8- 4,1)
IL-18 pg/mg19 (9 - 41)16 (8 - 33)#36 (13 - 300)35 (12 - 125)25 (10 - 62)88 (16 - 281)19 (9 - 41)16 (8 - 33)##36 (13 - 300)34 (10 - 115)18 (10 -65)#76 (20 - 261)
KIM-1 ng/mg0.2 (0.1- 0.3)***0.2 (0.1 - 0.5)###0.6 (0.3 - 1.2)0.3 (0.2 -0.8)**0.4 (0.2 - 0,8)##1,0 (0,5 - 1.8)0,7 (0,3 - 1,6)
*
0,7 (0,2 - 1,6)
##
2,0 (0,8 - 3,5)
1.0 (0.4 - 1.8)*1.0 (0.4- 1.8)#2.0 (1.3 - 5.1)
µAlb µg/mg6 (2 - 20)***6 (2 - 14)###44 (13 - 76)25 (11 - 68)*27 (16- 49)#69 (29 - 83)27 (9- 53)
16 (9 - 31)
#
31 (29 - 83)
27 (11 - 50)22 (10 - 40)33 (15- 69)
NGAL
µg/mg
26 (13 - 63)**27(13 - 60)##60 (43 - 369)46 (17 - 97)**42 (20 - 134)##191 (52 - 447)40 (17 - 87)
**
28 (11 - 76)
###
173 (59- 615)
48 (25- 134)*57 (25 - 139)243 (37 - 1518)

KDIGO II/III vs non-AKI: * p<0.05; ** p<0.01; *** p<0.001 KDIGO II/III vs KDIGO I: # p<0.05; ## p<0.01; ### p<0.001

Funding

  • Government Support - Non-U.S.