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Kidney Week

Abstract: FR-OR011

Reducing the Incidence of Post CABG AKI by Early Intervention Guided by Novel Urinary Biomarker (TIMP-2, IGFBP-7): An Institutional Experience

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Tiwary, Abhinav K., UMMS-Baystate , Springfield, Massachusetts, United States
  • Greco, Barbara A., Renal and Transplant Associates of New England, Springfield, Massachusetts, United States
  • Germain, Michael J., Renal and Transplant Assoc of New England, Hampden, Massachusetts, United States
  • Engelman, Daniel, Baystate Medical Center, Springfield, Massachusetts, United States
  • Agarwal, Krishna A., UMMS-Baystate , Chicopee, Massachusetts, United States
  • Golchin, Armand, UMMS-Baystate , Chicopee, Massachusetts, United States
  • Crisafi, Cheryl, UMMS-Baystate , Chicopee, Massachusetts, United States
Background

AKI post cardiac surgery occurs in up to 25% of patients: KDIGO AKI Stage 1 (30%), Stage 2 (10-15%), Stage 3 (2-5%), RRT (1%) and adversely affects prognosis, prolongs hospital stay and increases readmission rate. KDIGO guidelines recommend preventative measures in patients at high risk for developing AKI. In two multicenter studies of critically ill patients, NephroCheck (NC), urinary tissue inhibitor of metalloproteinases-2 (TIMP2) and insulin-like growth factor-binding protein 7 (IGFBP7), was validated for risk stratification for moderate-severe AKI.These markers are believed to reflect renal tubular epithelial cell response to stress and can identify patients at risk before injury occurs allowing for interventions to prevent AKI

Methods

Urinary NC was measured in CABG pts (n = 98) at our institution the morning after surgery. All pts with NC > 0.3 (moderate positive) received a modification of the KDIGO support measures. For NC > 0.6 (high positive), nephrology consultation was added. Patients with preoperative CKD were excluded. AKI was defined as rise in creatinine by 0.3 from baseline until hospital discharge.Interventions included goal-directed therapy for optimizing volume status, hemodynamics and renal perfusion pressure, raising the PAD pressure to 14-16 using balanced crystalloid, instituting inotropes for depressed cardiac function, limiting use of diuretics, avoidance of RAAS inhibitors, NSAIDs, and nephrotoxins, extending duration of hemodynamic monitoring, and using a higher transfusion threshold

Results

The AKI incidence (STS registry stage 3 KDIGO) prior to our study was 2.36 %. During the 6-month period using NC, the incidence of Stage 3 AKI fell to 1.25%. One false positive test was seen. One pt with a positive NC had a 2-hour UF post operatively; no other patients required RRT

Conclusion

The use of NC, a urinary biomarker for renal stress, in combination with rapid renal supportive interventions resulted in a 47% relative reduction in AKI in our institution in post CABG patients.