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Abstract: PO0139

Urine Biomarkers and Risk of Long-Term Kidney Outcomes After Cardiac Surgery: the TRIBE-AKI Study

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Menez, Steven, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
  • Moledina, Dennis G., Yale University School of Medicine, New Haven, Connecticut, 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, Institute for Clinical Evaluative Sciences, Toronto, 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
  • Mansour, Sherry, Yale University School of Medicine, New Haven, Connecticut, United States
  • Shlipak, Michael, University of California San Francisco, San Francisco, California, United States
  • 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

Group or Team Name

  • TRIBE-AKI Consortium
Background

The urine biomarkers epidermal growth factor (EGF) and monocyte chemoattractant protein-1 (MCP-1) show promise as biomarkers of chronic kidney disease (CKD) progression in settings such as diabetes mellitus, but their role in the transition from AKI to CKD remains unclear. EGF is produced specifically by renal tubular epithelium of the thick ascending limb and MCP-1 is extensively studied as a marker of kidney inflammation. We evaluated the associations of urine EGF and MCP-1 with CKD incidence or progression after cardiac surgery.

Methods

In this sub-study of the prospective TRIBE-AKI cohort, we evaluated 865 adult patients who underwent cardiac surgery from 2007–2010 at two sites in Canada and the US. We tested the association of first post-operative urine EGF and MCP-1, and the ratio EGF/MCP-1, with the composite outcome of CKD incidence or progression. We assessed for interaction by peri-operative AKI status.

Results

Over a median (IQR) follow-up of 5.8 (4.2-7.1) years, 266 (30.8%) patients developed the composite outcome at an event rate (95% CI) of 55.4 (49.2-62.5) per 1,000 person-years. Elevated levels of first post-operative urinary EGF and MCP-1 were each independently associated with the composite outcome, in opposing directions (Table 1), and the ratio (EGF/MCP-1) was strongly associated with decreased risk of CKD incidence or progression in both continuous and categorical analysis (aHR 0.50 [0.33-0.74] for T3 compared to T1). There was no interaction by AKI status.

Conclusion

Urine EGF and MCP-1 measured post-cardiac surgery were independently associated with CKD incidence and progression. The ratio of urine EGF/MCP-1 may be useful for risk prediction of future CKD outcomes after peri-operative injury in cardiac surgery.

Funding

  • NIDDK Support