Abstract: FR-PO075

Persistent Elevation of Biomarkers of Dysregulated Mineral Metabolism and Inflammation after AKI: The ASSESS-AKI Study

Session Information

  • AKI Clinical: Predictors
    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

  • Liu, Kathleen D., University of California San Francisco, San Francisco, California, United States
  • Chinchilli, Vernon M., Penn State College of Medicine, Hershey, Pennsylvania, United States
  • Kimmel, Paul L., National Institute of Diabetes and Digestive Kidney Diseases (NIDDK), Bethesda, Maryland, United States
  • Kaufman, James S., VA New York Harbor Healthcare System, New York, New York, United States
  • Go, Alan S., Kaiser Permanente Northern California, Oakland, California, United States
  • Hsu, Chi-yuan, University of California San Francisco, San Francisco, California, United States
  • Tan, Thida C., Kaiser Permanente Northern California, Oakland, California, United States
  • Arends, Valerie, University of Minnesota, Minneapolis, Minnesota, United States
  • Saenger, Amy, University of Minnesota, Minneapolis, Minnesota, United States
  • Parikh, Chirag R., Yale University and VAMC, New Haven, Connecticut, United States
  • Ikizler, Talat Alp, Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Himmelfarb, Jonathan, Kidney Research Institute, Seattle, Washington, United States
  • Wurfel, Mark M., University of Washington, Seattle, Washington, United States

Group or Team Name

  • For ASSESS-AKI Study Investigators
Background

AKI is associated with dysregulated mineral metabolism and inflammation. However, it is unknown if these abnormalities persist after AKI.

Methods

ASSESS-AKI is a parallel cohort study of hospitalized patients with and without AKI enrolled in 2009-2015, with matching based on center, age, baseline chronic kidney disease status, diabetes mellitus, prior cardiovascular disease, baseline eGFR, and ICU/non-ICU status during the index admission. Plasma biospecimens were collected at the index hospitalization (V0) and at the first outpatient 3-month study visit (V3).

Results

Mean age of the 1,484 participants analyzed was 55 yr and 48% were women. Baseline eGFR (from prior to the index hospitalization) was 69 mL/min/1.73m2. Compared to non-AKI patients, levels of parathyroid hormone (PTH), phosphorus, fibroblast growth factor-23 (FGF-23) and C-reactive protein (CRP) and were higher in AKI patients at both V0 and V3 (and higher among those with more severe AKI) (p< 0.001 for all comparisons). At V3, FGF-23 and phosphorus levels increased in both AKI and non-AKI participants, whereas CRP fell markedly (Table). In those with AKI, PTH levels fell modestly from V0 to V3, whereas there was no difference in non-AKI participants.

Conclusion

Markers of dysregulated mineral metabolism and inflammation are elevated during an episode of AKI; among these biomarkers, FGF-23 remains elevated months later. These raise the possibility that persistently dysregulated mineral metabolism may link AKI to adverse outcomes after hospital discharge.

 V0 : AKIV3: AKIP valueV0: No AKIV3: No AKIP value
PTH65 (41-103)54 (38.5-81)< 0.000148 (35-68.5)47 (36-62)0.17
Phosphorus3.1 (2.5-3.9)3.6 (3.2-4)< 0.00012.8 (2.4-3.4)3.5 (3.1-3.9)< 0.0001
FGF-2342.2 (20.7-88.7)66.5 (48.9-97.6)
< 0.000130.8 (18.6-48.7)
57.6 (45.6-78.5)< 0.0001
CRP118 (40-213)4.3 (1.8-10.5)< 0.000184.9 (18.5-173)3.0 (1.3-6.3)< 0.0001

Funding

  • NIDDK Support