Kidney Week

Abstract: FR-PO019

Endogenous Ouabain (EO) as Predictor of AKI and Post-Operative Outcomes

Session Information

• AKI: Clinical, Outcomes, Trials - I
  October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• Simonini, Marco, San Raffaele Scientific Institute, Milan, MILANO, Italy

Marco Simonini,

• Bignami, Elena Giovanna, University of Parma, Italy, Parma, Italy

Elena Giovanna Bignami,

• Casanova, Paola, San Raffaele Scientific Institute, Milan, MILANO, Italy

Paola Casanova,

• Meroni, Roberta, San Raffaele Scientific Institute, Milan, MILANO, Italy

Roberta Meroni,

• Lanzani, Chiara, San Raffaele Scientific Institute, Milan, MILANO, Italy

Chiara Lanzani,

• Messaggio, Elisabetta, San Raffaele Scientific Institute, Milan, MILANO, Italy

Elisabetta Messaggio,

• Delli carpini, Simona, San Raffaele Scientific Institute, Milan, MILANO, Italy

Simona Delli carpini,

• Citterio, Lorena, San Raffaele Scientific Institute, Milan, MILANO, Italy

Lorena Citterio,

• Manunta, Paolo, San Raffaele Scientific Institute, Milan, MILANO, Italy

Paolo Manunta,

Background

AKI is a frequent complication of cardiac surgery. A large number of novel postoperative biomarkers have been proposed to assess the risk of AKI. However, there are neither preoperative biomarkers nor robust validated risk models that predict AKI. EO is an adrenal stress hormone with hemodynamic and renal effects. Our group have already reported that higher pre-operative EO levels are associated with a worse renal outcome after cardiac surgery. Our aim is to confirm levels of EO as predictive biomarker of AKI in a larger population.

Methods

EO preoperative level was measured in 1097 patients admitted for elective cardiac surgery. For the analysis, patients were grouped according to EO preoperative levels: 1st group EO<133 pmol/L; 2nd EO 133-210 pmol/L; 3rd EO>210 pmol/L. According to the 3 groups, it was evaluated 1) incidence of AKI, 2) requirement of RRT and 3) total in-hospital mortality (IHM).

Results

In this extended population, we confirmed our previous observations for the great impact of preoperative EO level in the development of post-operative AKI. Patients with the highest EO values (>210 pmol/L) had highest postoperative AKI incidence (28.9% vs. 24.3% vs. 15.6%, p<0.0001, fig 1) and required more RRT (p=0.006) postoperatively. Moreover, we observed a relationship between EO and total In Hospital Morality (IHM occurred in 3.2% of patients presenting the highest levels of EO; p=0.028). All results were corrected for main clinical variable associated to post-operative AKI (as age, sex, EF, basal eGFR, surgery type, history of hypertension/diabetes; re-intervention).

Conclusion

These results confirmed preoperative EO level as predictive for the outcomes in patients undergoing cardiovascular surgery: subjects with the highest level of preoperative plasma EO experienced the worst outcomes (increased incidence of AKI, use of RRT and IHM).