Kidney Week

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

Kathleen D. Liu,

• Hsu, Chi-yuan, University of California San Francisco, San Francisco, California, United States

Chi-yuan Hsu,

• Tan, Thida C., Kaiser Permanente Northern California, Oakland, California, United States

Thida C. Tan,

• Arends, Valerie, University of Minnesota, Minneapolis, Minnesota, United States

Valerie Arends,

• Saenger, Amy, University of Minnesota, Minneapolis, Minnesota, United States

Amy Saenger,

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

Chirag R. Parikh,

• Ikizler, Talat Alp, Vanderbilt University Medical Center, Nashville, Tennessee, United States

Talat Alp Ikizler,

• Himmelfarb, Jonathan, Kidney Research Institute, Seattle, Washington, United States

Jonathan Himmelfarb,

• Wurfel, Mark M., University of Washington, Seattle, Washington, United States

Mark M. Wurfel,

• Chinchilli, Vernon M., Penn State College of Medicine, Hershey, Pennsylvania, United States

Vernon M. Chinchilli,

• Kimmel, Paul L., National Institute of Diabetes and Digestive Kidney Diseases (NIDDK), Bethesda, Maryland, United States

Paul L. Kimmel,

• Kaufman, James S., VA New York Harbor Healthcare System, New York, New York, United States

James S. Kaufman,

• Go, Alan S., Kaiser Permanente Northern California, Oakland, California, United States

Alan S. Go,

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.

Funding

• NIDDK Support