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Abstract: PO0049

Preoperative Urine Alpha 1 Microglobulin Levels Are Associated with AKI and Mortality After Cardiac Surgery

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Amatruda, Jonathan G., University of California San Francisco, San Francisco, California, United States
  • Garg, Amit X., Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
  • Thiessen Philbrook, Heather, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
  • McArthur, Eric, ICES, London, Ontario, Canada
  • Coca, Steven G., Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Parikh, Chirag R., Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
  • Shlipak, Michael, University of California San Francisco, San Francisco, California, United States

Group or Team Name

  • TRIBE-AKI Consortium.
Background

Higher urine alpha-1 microglobulin (a1m) levels are a marker of proximal tubule dysfunction and may improve CKD assessment and risk stratification. We hypothesized that a1m levels would be associated with adverse outcomes after cardiac surgery.

Methods

In 1464 adults undergoing cardiac surgery (CABG and/or valve) and prospectively enrolled in the multicenter TRIBE-AKI study, we measured urine a1m pre- and post-operatively. Outcomes were post-operative AKI during index hospitalization (AKIN stage ≥1) and all-cause mortality (median follow-up (IQR) 6.7 (4.0, 7.9) years). Urine a1m was analyzed as a continuous (log2) predictor in multivariable analyses adjusting for demographics, surgery characteristics, comorbidities, baseline eGFR, urine albumin, and urine creatinine.

Results

There were 230 AKI events and 459 deaths. Higher pre-operative a1m was independently associated with AKI (aOR=1.36, 95% CI 1.14-1.62) and all-cause mortality (aHR=1.19, 95% CI 1.06-1.33) (see table). We observed a significant interaction (p=0.01), whereby a1m had a stronger association with mortality in the subset without CHF (aHR=1.29, 95% CI 1.12-1.47) than among those with CHF (aHR=1.06, 95% CI 0.85-1.32). However, post-operative changes in a1m were not associated with AKI or mortality risk.

Conclusion

Even after adjusting for baseline kidney function and comorbidities, pre-operative a1m was associated with post-operative AKI and all-cause mortality.

Funding

  • Other NIH Support