Abstract: SA-PO878
Pre-Operative Biomarkers and Risk for CKD After Cardiac Surgery
Session Information
- CKD: Pharmacoepidemiology
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Coca, Steven G., Icahn School of Medicine at Mount Sinai, New York, New York, United States
- Menez, Steven, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Moledina, Dennis G., Yale School of Medicine, New Haven, Connecticut, United States
- McArthur, Eric, Institute for Clinical Evaluative Sciences, London, Ontario, Canada
- Jia, Yaqi, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Obeid, Wassim, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Liu, Caroline, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Mansour, Sherry, Yale School of Medicine, New Haven, Connecticut, United States
- Thiessen Philbrook, Heather, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Shlipak, Michael, San Francisco VA Medical Center, San Francisco, California, United States
- Garg, Amit X., London Health Sciences Centre, London, Ontario, Canada
- Parikh, Chirag R., Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
Group or Team Name
- TRIBE-AKI Consortium
Background
The associations between various biomarkers and long-term kidney outcomes after cardiac surgery are unknown.
Methods
In patients undergoing cardiac surgery who were enrolled in the TRIBE-AKI study, we assessed the associations of 32 plasma and 8 urine biomarkers measured pre-operatively with the composite kidney endpoint of incident CKD or progression of existing CKD. 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 of the two cohorts. In the exploration cohort, top biomarkers were identified from the 40 candidate biomarkers. Results were confirmed in the replication cohort, thereby reducing resubstitution and model selection biases. Estimates were pooled for biomarkers that were statistically significant in both the derivation and replication cohorts. Cox proportional hazard regression models adjusted for age, sex, AKI stage, pre-op albuminuria, pre-op SCr, discharge SCr estimated the relationship of the biomarkers with the CKD outcome.
Results
After a median (IQR) follow-up of 5.6 (4.3-5.8) years, a total of 172 (28%) patients experienced the CKD endpoint. 7 plasma and 0 urine biomarkers were independently associated with the CKD endpoint in the exploration cohort, of which 4 biomarkers retained statistical significance in the replication cohort and upon pooling. The pooled HRs (95% CI) per natural log increase were as follows: TNFR1 2.3 (1.6, 3.2), TNFR2 1.7 (1.2, 2.3), KIM1 1.8 (1.3, 2.4), NT-proBNP 1.2 (1.1, 1.4) (Table).
Conclusion
Pre-operative plasma TNFR1, TNFR2, KIM-1 and NT-proBNP were associated with incidence and progression of CKD several years after cardiac surgery. As in other clinical settings, these biomarkers may provide prognostic value for long-term kidney outcomes after cardiac surgery.
Funding
- Other NIH Support