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Kidney Week

Abstract: FR-PO015

Biomarkers of Kidney Injury and Repair and Risk for Future Kidney Events: The ASSESS-AKI Study

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Puthumana, Jeremy, Yale School of Medicine, New Haven, Connecticut, United States
  • Liu, Kathleen D., University of California at San Francisco School of Medicine, San Francisco, California, United States
  • Siew, Edward D., Vanderbilt University School of Medicine, Nashville, Tennessee, United States
  • Reeves, William Brian, University of Texas Health Science Center San Antonio, San Antonio, Texas, United States
  • Himmelfarb, Jonathan, Kidney Research Institute, Seattle, Washington, United States
  • Coca, Steven G., Icahn School of Medicine at Mount Sinai, 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
  • Ikizler, Talat Alp, Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Wurfel, Mark M., University of Washington, Seattle, Washington, United States
  • Garg, Amit X., London Health Sciences Centre, London, Ontario, Canada
  • Kaufman, James S., VA New York Harbor Healthcare System, New York, New York, United States
  • Kimmel, Paul L., National Institute of Diabetes and Digestive Kidney Diseases (NIDDK), Bethesda, Maryland, United States
  • Chinchilli, Vernon M., Penn State College of Medicine, Hershey, Pennsylvania, United States
  • Parikh, Chirag R., Yale University and VAMC, New Haven, Connecticut, United States

Group or Team Name

  • ASSESS-AKI Study Investigators
Background

Acute kidney injury (AKI) is a complex disorder associated with increased risk of CKD and mortality. While kidney function may improve after an episode of AKI, subclinical kidney damage may remain that connotes propensity for GFR decline over time. We sought to examine the utility of biomarkers associated with renal injury and repair during and after AKI.

Methods

In a prospective longitudinal parallel cohort study, we enrolled 769 adults hospitalized with AKI and 769 hospitalized adults without AKI from 4 centers in North America. Interleukin-18 (IL-18), neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), monocyte chemoattractant protein-1 (MCP-1), uromodulin (UMOD), and YKL-40 were measured in urine samples collected during index hospitalization and outpatient follow-up at 3 months. We followed patients for a median of 4.2 years and assessed the association of the biomarkers with a composite renal outcome (CKD incidence, CKD progression, or ESRD) and death.

Results

Urinary biomarkers at the time of index hospitalization were not significantly associated with the composite renal outcome or death. As shown in Figure, urinary IL-18, NGAL, KIM-1, MCP-1, and YKL-40 at 3 months were independently associated with risk of renal events in adjusted analyses. In addition, higher urinary NGAL and YKL-40 levels at 3 months were independently associated with increased risk of mortality.

Conclusion

Urine biomarkers were detectable at 3 months, suggesting ongoing inflammation, repair, and fibrosis even after clinical AKI has resolved. Biomarker levels at 3 months identify patients at risk for renal events and death.

Funding

  • NIDDK Support