ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: SA-OR045

Blood and Urine Biomarkers and CKD After Cardiac Surgery

Session Information

  • Biomarkers in CKD
    November 09, 2019 | Location: 152, Walter E. Washington Convention Center
    Abstract Time: 05:54 PM - 06:06 PM

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Menez, Steven, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
  • Moledina, Dennis G., Yale School of Medicine, New Haven, Connecticut, United States
  • Garg, Amit X., London Health Sciences Centre, London, Ontario, Canada
  • Thiessen Philbrook, Heather, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
  • McArthur, Eric, Institute for Clinical Evaluative Sciences, London, Ontario, Canada
  • Jia, Yaqi, Johns Hopkins University, Newton, Massachusetts, United States
  • Liu, Caroline, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
  • Obeid, Wassim, John Hopkins University, Baltimore, Maryland, United States
  • Mansour, Sherry, Yale School of Medicine, New Haven, Connecticut, United States
  • Koyner, Jay L., University of Chicago, Chicago, Illinois, United States
  • Shlipak, Michael, San Francisco VA Medical Center, San Francisco, California, United States
  • Wilson, Francis Perry, Yale School of Medicine, New Haven, Connecticut, United States
  • Coca, Steven G., Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Parikh, Chirag R., Johns Hopkins University, Newton, Massachusetts, United States

Group or Team Name

  • TRIBE-AKI Consortium
Background

The use of blood and urine biomarkers of injury, inflammation and repair in the post-operative period following cardiac surgery may help identify patients at increased risk for longer-term adverse kidney outcomes. We investigated the independent associations between candidate biomarkers and CKD incidence or progression following cardiac surgery.

Methods

We prospectively enrolled adult patients undergoing cardiac surgery (CABG or valve) in 2 academic centers from 2007–2010 as part of the TRIBE-AKI Study. The cohort was separated into exploration (Canada n=613) and replication (USA n=310) cohorts due to differences in outcome ascertainment and lack of data integration. Top biomarkers were identified from candidate post-operative biomarkers (32 blood, 8 urine) in the exploration cohort and confirmed in the replication cohort, thereby reducing model selection bias. Our primary outcome was a composite of CKD incidence or progression. In those with a pre-operative eGFR≥60, CKD incidence was defined as a 25% reduction in eGFR and a fall below 60. In those with a pre-operative eGFR<60, CKD progression was defined as a 50% reduction in eGFR or a fall below 15.

Results

172 (28.1%) patients in the exploration cohort developed the primary outcome after a median (IQR) follow-up of 5.61 (4.30-6.84) years. 8 biomarkers were associated with the primary outcome, of which 3 remained significant after full adjustment. Each log increase in post-operative levels of bFGF (HR 1.52 [1.19, 1.93]), N-terminal pro-BNP (HR 1.19 [1.01, 1.41]), and TNF-r1 (HR 1.75 [1.18, 2.59]) were independently associated with the primary outcome (Table 1). Similar estimates were found in the replication cohort, with pooled estimates showing little heterogeneity (I2=0).

Conclusion

Elevated post-operative levels of bFGF, NT pro-BNP, and TNF-r1 were associated with the CKD outcome. These biomarkers provide additional value in evaluating CKD incidence and progression after cardiac surgery.

Funding

  • NIDDK Support