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Kidney Week

Abstract: SA-OR013

Association Between Urinary Dickkopf-3, AKI, and Subsequent Loss of Kidney Function in Patients Undergoing Cardiac Surgery: An Observational Cohort Study

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Speer, Thimoteus, Saarland University Hospital, Homburg/Saar, Germany
  • Schunk, Stefan J., Saarland University Hospital, Homburg/Saar, Germany
  • Zarbock, Alexander, University Hospital Münster, Münster, Germany
  • Kellum, John A., University of Pittsburgh, Pittsburgh, Pennsylvania, United States
  • Fliser, Danilo, Saarland University, Homburg/Saar, Germany
  • Zewinger, Stephen, Saarland University Hospital, Homburg/Saar, Germany
Background

Cardiac surgery is associated with a high risk of postoperative acute kidney injury (AKI) and subsequent loss of kidney function. We explored the clinical utility of urinary dickkopf-3 (DKK3), a renal tubular stress marker, for preoperative identification of patients at risk for AKI and subsequent kidney function loss.

Methods

The study comprised consecutive patients who had elective cardiac surgery at the Saarland University Medical Centre (Homburg, Germany; derivation cohort) and those undergoing elective cardiac surgery who were enrolled in the prospective RenalRIP multicentre trial (validation cohort) and who were randomly assigned to remote ischaemic preconditioning or a sham procedure. The association between the ratio of preoperative urinary concentrations of DKK3 to creatinine (DKK3:creatinine) and postoperative AKI, and subsequent kidney function loss was assessed.

Results

In the 733 patient in the derivation cohort, urinary concentrations of DKK3 to creatinine that were higher than 471 pg DKK3 per milligram of creatinine were associated with significantly increased risk for AKI (OR 1.65, 95% CI 1.10–2.47, p=0.015), independent of baseline kidney function. High urinary DKK3:creatinine concentrations were independently associated with significantly lower kidney function at hospital discharge and after a median follow-up of 820 days. In the RenalRIP trial, preoperative urinary DKK3:creatinine concentrations higher than 471 pg/mg were associated with a significantly higher risk for AKI (OR 1.94, 95% CI 1.08–3.47, p=0.026), persistent renal dysfunction (OR 6.67, 1.67–26.61, p=0.0072), and dialysis dependency (OR 13.57, 1.50–122.77, p=0.020) after 90 days compared with DKK3:creatinine concentrations of 471 pg/mg or less. Urinary DKK3:creatinine concentrations higher than 471 pg/mg were associated with significantly higher risk for AKI and persistent renal dysfunction only in patients having a sham procedure, but not remote ischaemic preconditioning.

Conclusion

Preoperative urinary DKK3 is an independent predictor for postoperative AKI and for subsequent loss of kidney function. Urinary DKK3 might aid in the identification of patients in whom preventive treatment strategies are effective.