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Kidney Week

Abstract: TH-PO050

Circulating Cardiac Stress, Vascular Dysfunction, and Inflammatory Biomarkers Predict AKI in French Type 2 Diabetes Patients: The SURDIAGENE Cohort

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Sautenet, Benedicte, CHRU Tours, Tours, France
  • Saulnier, Pierre Jean, CHU Poitiers, Poitiers, France
  • Elise, Gand, CHU Poitiers, Poitiers, France
  • Roussel, Ronan, INSERM, Paris, France
  • Ragot, Stephanie, University of Poitiers, Poitiers, France
  • Velho, Gilberto, INSERM, Paris, France
  • Hadjadj, Samy, CHU Poitiers, Poitiers, France
Background

Acute kidney injury (AKI) is related to chronic kidney disease and death in patients from the general population, with or without type 2 diabetes. Nevertheless AKI biomarkers are rarely validated in diabetes population. We aimed to explore the individual and combined prognostic value of 8 circulating candidate markers for AKI.

Methods

We prospectively followed-up 1345 (565 women/780 men) type 2 diabetes participants of a French single-centre hospital-based cohort (SURDIAGENE) with baseline GFR≥30 ml/min/1.73m2 and no renal replacement to onset of AKI, death, or December 31, 2015. Intrahospital AKI was diagnosed and staged using the KDIGO criteria. We assessed 3 markers of cardiac and endothelial dysfunction (mid-regional-pro-adrenomedullin [MRproADM], angiopoietinlike-2 [ANGPTL2], N-terminal prohormone brain natriuretic peptide [NTproBNP]), 1 of oxidative stress (fluorescent advanced glycation endproducts [AGE], carbonyls), 1 for cardio-renal pathways (copeptin [CTproAVP]), and 1 of inflammation (soluble TNF receptor 1 [TNFR1]). Cox models were used to estimate the risk of AKI for each biomarker at baseline after adjustement for usual risk factors: sex, diabetes duration, HbA1c, systolic blood pressure, GFR, ACR, use of antihypertensive, and history of cardiovascular disease. Hazard ratios were reported per 1 SD increment of the logarithm of the biomarker concentration.

Results

At baseline, mean±SD age was 64±11 years, diabetes duration 14±10 years, HbA1c 7.8±1.6%, and eGFR 77±21 ml/min/1.73m2, and median (IQR) ACR 3 (1-10) mg/mmol. During a median follow-up of 4.7 years, 449 (33%) patients developed an AKI. In univariate analysis, each biomarker was significantly associated with AKI, and 6 remained associated after multivariable adjustment (Table). The addition of a multimarker score summing standardized and weighted values of these 6 markers to the model including usual risk factors significantly improved C-statistics (0.724 to 0.759, P<0.0001), and 5-year risk-predictive performance (relative integrated discrimination improvement index=0.435, P<0.0001).

Conclusion

A panel of 6 biomarkers representing cardiac, vascular and inflammatory pathways improved the prediction of AKI over usual risk factors in patients with type 2 diabetes.