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Abstract: PO0140

Higher Plasma KIM-1 Is Associated with Increased Mortality and Decreased Renal Recovery in Patients with AKI Requiring Renal Replacement Therapy

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Kelly, Yvelynne P., Brigham and Women's Hospital, Boston, Massachusetts, United States
  • McCausland, Finnian R., Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Mendu, Mallika L., Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Sabbisetti, Venkata, Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Leaf, David E., Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Waikar, Sushrut S., Boston Medical Center, Boston, Massachusetts, United States
Background

Plasma kidney injury molecule-1 (KIM-1), a protein synthesized by renal proximal tubular cells, increases during periods of ischemia and thereby acts as a sensitive marker for AKI severity. We hypothesized that higher plasma KIM-1 levels assessed prior to commencing renal replacement therapy (RRT) would associate with higher mortality and RRT dependence in critically ill patients with severe AKI.

Methods

We measured plasma KIM-1 levels in 806 Day 0 samples from participants in Acute renal failure Trial Network (ATN) trial, a randomized controlled trial of intensive versus less-intensive RRT. For our primary analysis we used a logistic regression model to assess the risk of 28-day mortality and an inverse probability weighted logistic regression model to assess the odds of 28-day renal recovery, per doubling in log-transformed Day 0 KIM-1. Both models were adjusted for components of the ATN trial mortality risk score (age, chronic hypoxemia, CVS disease, malignancy, immunosuppressive therapy, ischemic AKI, post open surgery and vital signs at RRT initiation).

Results

Higher levels of plasma KIM-1 were associated with an increased risk of death within 28 days (adjusted odds ratio 1.15; 95% CI 1.03-1.29; p = 0.02) per doubling in log-transformed plasma KIM-1. Higher levels of Day 0 plasma KIM-1 were also associated with an increased risk of persistent RRT dependence at 28 days (adjusted odds ratio 0.76; 95% CI 0.66-0.87; p < 0.0001) per doubling in log-transformed plasma KIM-1.

Conclusion

Higher plasma KIM-1 levels measured prior to initiation of RRT are independently associated with higher 28-day mortality and lower probability of 28-day renal recovery in critically ill patients with severe AKI.

Baseline demographic and illness severity data according to Day 0 KIM-1 quartile