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Kidney Week

Abstract: FR-OR06

Role of Angiopoietins in CKD Progression After Hospitalization

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Mansour, Sherry, Yale University School of Medicine, New Haven, Connecticut, United States
  • Coca, Steven G., Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Jia, Yaqi, Johns Hopkins University, Baltimore, Maryland, United States
  • Chinchilli, Vernon M., Pennsylvania State University, University Park, Pennsylvania, United States
  • Obeid, Wassim, Johns Hopkins University, Baltimore, Maryland, United States
  • Wilson, Francis Perry, Yale University School of Medicine, New Haven, Connecticut, United States
  • Parikh, Samir M., Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
  • Siew, Edward D., Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Ikizler, Talat Alp, Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Himmelfarb, Jonathan, University of Washington, Seattle, Washington, United States
  • Kimmel, Paul L., National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, United States
  • Parikh, Chirag R., Johns Hopkins University, Baltimore, Maryland, United States

Group or Team Name

  • ASSESS-AKI Consortium
Background

The factors determining chronic kidney disease (CKD) progression after an episode of acute kidney injury (AKI) are poorly understood. Angiopoietins play a role in vessel remodeling after AKI, where Angiopoietin-1 (Angpt-1) maintains vessel stability and Angiopoietin-2 (Angpt-2) destabilizes quiescent vessels. We investigated whether the balance of Angpt-1 and -2 was prognostic of CKD and mortality after hospitalization in patients with and without AKI.

Methods

Using plasma samples from ASSESS-AKI, we measured Angiopoietins 3 months after hospitalization. We assessed the ratio of Angpt-1:Angpt-2 with CKD progression (composite of incident and progression of CKD, and end stage kidney disease), and all-cause mortality.

Results

Angiopoietins were measured in 1503 hospitalized patients, among whom 746 (49.6%) had AKI. Median (IQR) age was 65.8 (56.6, 73.9) years, 555 (37%) were female, and 196 (13%) were black. Median times to CKD progression, and all-cause mortality were 4.4 (2.5, 5.7), and 4.9 (3.6, 6.0) years, respectively. CKD progression developed in 293 (19%) and mortality in 314 (21%) participants. The highest quartile of Angpt-1:Angpt-2 ratio was independently associated with 50% reduced risk of CKD progression and 77% reduced risk of mortality as compared to the lowest quartile. Stratified analyses by AKI status revealed stronger associations between Angpt-1:Angpt-2 ratio and both outcomes in the AKI group (Figure).

Conclusion

A higher Angpt-1:Angpt-2 ratio was strongly associated with lower risk of CKD progression and mortality after hospitalization, particularly in patients with AKI. Angiopoietins may help risk stratify patients with AKI after discharge for those in need of close follow-up and CKD management.

Funding

  • Private Foundation Support