Kidney Week

Abstract: TH-PO1109

Plasma TNF Receptor Concentrations After Hospitalization with AKI and Long-Term CKD and Mortality

Session Information

• CKD: Clinical, Outcomes, Trials - I
  October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 1902 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Coca, Steven G., Icahn School of Medicine at Mount Sinai, New York, New York, United States

Steven G. Coca,

• Moledina, Dennis G., Yale School of Medicine, New Haven, Connecticut, United States

Dennis G. Moledina,

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

Mark M. Wurfel,

• Siew, Edward D., Vanderbilt University School of Medicine, Nashville, Tennessee, United States

Edward D. Siew,

• Garg, Amit X., London Health Sciences Centre, London, Ontario, Canada

Amit X. Garg,

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

Chi-yuan Hsu,

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

James S. Kaufman,

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

Paul L. Kimmel,

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

Chirag R. Parikh,

Group or Team Name

• ASSESS-AKI

Background

Plasma tumor necrosis factor receptor (TNFR)1 and TNFR2 provide prognostic information in ambulatory patients with diabetic kidney disease, but their utility in patients after an episode of AKI is unknown.

Methods

Hospitalized adults with and without AKI were enrolled in a parallel, matched cohort from 4 centers between 2009-2015 and had plasma TNFR1 and TNFR2 measured at the outpatient baseline visit within 3 months post-discharge. We tested for associations between biomarkers, expressed continuously and by quartiles, with time until the composite kidney outcome (CKD incidence, CKD progression, or ESRD) and death via a multivariable Weibull regression model that accounted for (1) the 1:1 matching of adults and (2) competing risk. We adjusted for demographics, comorbidities, AKI status during hospitalization, and concurrent eGFR, UACR, and CRP at the baseline visit.

Results

Among 1377 participants, median concentrations of TNFR1 and TNFR2 decreased from 3976 [IQR 2791-5936] and 8485 [IQR 5865-12774] pg/mL during hospitalization, to 2829 [IQR 2064-4162] and 6661 [IQR 4758-9692] pg/mL at the post-discharge baseline visit, respectively. The composite CKD outcome occurred in 257 (19%) and death before CKD occurred in 212 (15%) over a median follow-up of 4.2 years, and these events occurred more frequently in those with higher concentrations of each biomarker. After adjustment for a comprehensive panel of covariates, plasma TNFR1 and TNFR2 were independently associated with both the CKD outcome and death (Figure).

Conclusion

In hospitalized patients that survived at least 3 months, plasma TNFR1 and TNFR2 provide additional risk-stratification for kidney outcomes and death, even after accounting for concurrent measures of kidney function, albuminuria, and systemic inflammation.

Association of Plasma TNFR1 and TNFR2 with Outcomes in the ASSESS-AKI Study

Funding

• NIDDK Support