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Kidney Week

Abstract: TH-PO098

Admission Plasma Uromodulin and the Risk of AKI in Hospitalized Patients with Cirrhosis

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Patidar, Kavish Rohit, Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Garimella, Pranav S., University of California San Diego, San Diego, California, United States
  • Macedo, Etienne, University of California San Diego, San Diego, California, United States
  • El-Achkar, Tarek M., Indiana University, Indianapolis, Indiana, United States
Background

Acute kidney injury (AKI) is a common complication in patients hospitalized with decompensated cirrhosis. Current methods for identifying patients at risk for AKI are suboptimal. Uromodulin, a protein uniquely produced by the kidney and released both in the urine and circulation, has been shown to regulate AKI and is linked to tubular reserve. Although low levels of urine uromodulin are associated with an increased risk of AKI after cardiac surgery, it is unclear whether circulating uromodulin can stratify the risk of AKI, particularly in a susceptible population such as patients with cirrhosis.

Methods

Patients admitted with cirrhosis were monitored for subsequent hospital-acquired AKI (defined by a rise in serum creatinine more than 0.3mg/dL within 48 hours or 1.5 fold increase compared to baseline). Plasma levels of uromodulin were measured at the time of hospital admission. Multivariable logistic regression adjusted for significant clinical variables was used to evaluate the associations between admission uromodulin and odds of developing AKI.

Results

98 patients [mean age 54 years, Model for Endstage Liver Disease Sodium score (MELD-Na) 19, and baseline creatinine of 0.95 mg/dl] were included, of which 13% (n=13) developed AKI. Median uromodulin levels were significantly lower in patients who developed AKI compared to patients who did not (9.30 vs. 13.35 ng/mL, p=0.02). After adjusting for age, sex, diabetes, hypertension, albumin, and MELD-Na score (which includes kidney function) as co-variates, uromodulin was independently associated with AKI [OR of 1.19 (95% CI 1.02, 1.37; p=0.02)].

Conclusion

Lower uromodulin levels on admission are associated with increased odds of subsequent AKI in hospitalized patients with cirrhosis.To our knowledge, this is the first study linking plasma uromodulin with AKI development, albeit in a unique population of patients with cirrhosis.
If validated in larger studies, the measurement of circulating uromodulin on admission could enhance our clinical decision making for risk assessment of AKI in patients with liver disease.

Funding

  • NIDDK Support