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Abstract: FR-PO016

Early increase in Renal Injury Urinary Biomarkers Associated with AKI Development in Major Elective Non-Vascular Abdominal Surgeries

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Marçal, Lia Junqueira, University of Sao Paulo Medical School, Sao Paulo, Brazil
  • de Souza, Graziela Ramos barbosa de, University of Sao Paulo Medical School, Sao Paulo, Brazil
  • Torres, Veronica, University of Sao Paulo Medical School, Sao Paulo, Brazil
  • Azevedo, Flávia Barros, University of Sao Paulo Medical School, Sao Paulo, Brazil
  • Zanetta, Dirce M T, University of São Paulo, S Paulo, Brazil
  • Yu, Luis, University of Sao Paulo Medical School, Sao Paulo, Brazil
  • Antonangelo, Leila, University of Sao Paulo Medical School, Sao Paulo, Brazil
  • Burdmann, Emmanuel A., University of Sao Paulo Medical School, Sao Paulo, Brazil
Background

There are few data on the incidence of acute kidney injury (AKI) diagnosed by KDIGO criteria and the role of renal injury urinary biomarkers (uBMs) for predicting AKI in patients (pts) submitted to major elective non-vascular abdominal surgeries (MENVAS).

Methods

A total of 225 pts were evaluated, peri-operatively and from the ICU admission up to 7 days. Serum Creatinine (SCr) was assessed before surgery and once a day up to 7d or until ICU discharge. Hourly Urinary Ouput (ml/kg/h) was measured daily. AKI was diagnosed using either SCr or/and urinary output (UO) according to KDIGO definitions. Urine sample was collected 1 day before surgery (baseline), 30 min, 12 and 24h after ICU admission. Five uBMs were assessed: monocyte chemotactic protein 1 (MCP-1), interleukin 18 (IL-18), kidney injury molecule-1 (KIM-1), microalbuminuria (µalb) and neutrophil gelatinase-associated lipocalin (NGAL) by Luminex x-MAP method. Data are presented as median (first and third quartiles) or frequency. Statistical significance was p<0.05.

Results

Overall, age was 55±15y, 58,2% were female, hospital LoS was 17,7±16.9d, ICU LoS was 3.2±3.2d and mortality was 6,7%. A total of 126 pts (56%) developed AKI - majority KDIGO I (77,8%). Those developing AKI KDIGO II and III had significantly higher BMs values compared to pts AKI KDIGO I or non-AKI in all studied times, but the SCr didn’t rise at the same period (IMAGE 1). UO has the best performance: 77,6% pts (KDIGO I) and 89,3% (KDIGO II and III) in 6h; NGAL showed a good performance 24h after ICU admission.

Conclusion

We found a strikingly high incidence of MENVAS-associated AKI diagnosed by KDIGO criteria in patients admitted ICU. Those who developed more severe AKI showed significantly higher uBMs in all times studied, including the preoperative period. uBM increase earlier and before SCr.

Funding

  • Government Support - Non-U.S.