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Kidney Week

Abstract: TH-PO049

Predictive Value of Current Biomarkers for Early Reversal of AKI

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Peerapornratana, Sadudee, University of Pittsburgh, Pittsburgh, United States
  • Priyanka, Priyanka, The University of Pittsburgh, Pittsburgh, Pennsylvania, United States
  • Kellum, John A., University of Pittsburgh, Pittsburgh, Pennsylvania, United States

Group or Team Name

  • Center for Critical Care Nephrology, The CRISMA Laboratory, Department of Critical Care Medicine, University of Pittsburgh
Background

Acute kidney injury (AKI) is associated with various recovery patterns. Early reversal of AKI is common in critically ill patients and associated with good outcomes. The predictive role of current biomarkers for reversal of AKI is still unknown.

Methods

Using data from an ancillary study to a large randomized trial, including 1,341 patients with septic shock we focused on patients with stage 2 or 3 AKI at presentation or manifesting within the first day of hospital admission. Early reversal of AKI was defined as no longer meet any criteria for AKI (for at least 24 hours) on any day within the 7 days after first documented AKI. Any subsequent AKI episode after initial reversal was considered a relapse. Final recovery status was then assessed at hospital discharge. Several urinary biomarkers were measured at 24 hours after enrollment and used for prediction of early reversal.

Results

Among the 604 patients with KDIGO stage 2 or 3 AKI, 345 (57.1%) patients had early reversal of renal function. Of these, 50 (14.5%) patients had a relapse of AKI during their hospital stay after early reversal. A total of 327 (54.1%) patients finally had recovery at hospital discharge. About 40% of patients never reversed AKI. None of the urinary biomarkers TIMP-2●IGFBP7, NGAL, Kim-1, L-FABP, or type IV collagen were predictive of early reversal of AKI (C-statistics: 0.37, 0.45, 0.49, 0.48, 0.45, respectively). Patients who had early sustained reversal of renal function experienced the best survival at day 90, while those who had relapse of AKI and those who never recovered had the worst outcomes.

Conclusion

Currently available AKI biomarkers are not useful for prediction of early reversal of renal function after AKI. Novel predictive biomarkers for renal recovery are needed.

Survival by recovery patterns.