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Kidney Week

Abstract: FR-PO025

Different Roles of Functional and Structural Markers Measured at Discontinuation of Renal Replacement Therapy for AKI

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Yoshida, Teruhiko, The University of Tokyo Hospital, Tokyo, Japan
  • Matsuura, Ryo, The University of Tokyo Hospital, Tokyo, Japan
  • Miyamoto, Yoshihisa, The University of Tokyo Hospital, Tokyo, Japan
  • Komaru, Yohei, The University of Tokyo Hospital, Tokyo, Japan
  • Isegawa, Takuya, The University of Tokyo Hospital, Tokyo, Japan
  • Hamasaki, Yoshifumi, University of Tokyo, Tokyo, Japan
  • Noiri, Eisei, University of Tokyo, Tokyo, Japan
  • Nangaku, Masaomi, the University of Tokyo School of Medicine, Tokyo, Japan
  • Doi, Kent, University of Tokyo, Tokyo, Japan
Background

Severe acute kidney injury (AKI) which requires renal replacement therapy (RRT) has been reported to show unacceptably high mortality of 50% or more. Successful discontinuation of RRT is supposed to be associated with better outcomes. Although functional and structural markers have been evaluated in AKI, little is known about their roles in predicting outcomes when measured at the time of RRT discontinuation.

Methods

We performed a prospective single-center cohort study. Patients received continuous RRT (CRRT) for AKI between August 2016 and March 2018 in the intensive care unit of The University of Tokyo Hospital (Tokyo, JAPAN) were analyzed. Clinical parameters and urine samples were obtained at CRRT discontinuation. Successful CRRT discontinuation was defined as neither resuming CRRT for 48 hours nor receiving intermittent hemodialysis during 7 days from the CRRT termination. Major adverse kidney events (MAKEs) was defined as death or dialysis requirement or more than 25% reduction of eGFR from the baseline at day 90.

Results

73 patients who received CRRT for AKI were analyzed. 59 discontinued patients and 14 un-discontinued patients were identified. Among kinetic eGFR, urine volume, urinary NGAL and urinary L-FABP, urine volume had the highest AUC [95%CI] 0.91 [0.80-0.96] with the cut-off value of 740 ml/day. For predicting MAKEs at day 90, urinary NGAL had the highest AUC 0.76 [0.62-0.86], whereas kinetic GFR and urine volume failed to show statistical significance (kinetic eGFR AUC 0.49 [0.35-0.63], urine volume AUC 0.59 [0.44-0.73]).

Conclusion

Our prospective study revealed functional marker of urine volume could predict successful weaning of RRT, on the other hand, structural maker of urinary NGAL could predict long-term renal outcomes. This indicates different roles of functional and structural makers in predicting the outcomes of severe AKI requiring RRT.

Funding

  • Government Support - Non-U.S.