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Abstract: PO0064

Renin Levels Are Higher in Patients with AKI and Associate with Mortality and Major Adverse Kidney Events

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Ortiz-Soriano, Victor M., University of Kentucky, Lexington, Kentucky, United States
  • Gianella, Fabiola, University of Texas Southwestern Medical School, Dallas, Texas, United States
  • Flannery, Alexander H., University of Kentucky, Lexington, Kentucky, United States
  • Li, Xilong, University of Texas Southwestern Medical School, Dallas, Texas, United States
  • Parikh, Chirag R., Johns Hopkins University, Baltimore, Maryland, United States
  • Mansour, Sherry, Yale University School of Medicine, New Haven, Connecticut, United States
  • Moe, Orson W., University of Texas Southwestern Medical School, Dallas, Texas, United States
  • Goldstein, Stuart, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Neyra, Javier A., University of Kentucky, Lexington, Kentucky, United States
Background

Renin is a marker of tissue perfusion and may be useful in predicting mortality in critically ill patients. Renin might also reflect structural kidney damage in heterogeneous AKI settings. We examine if renin levels are different in patients with vs. without AKI and if renin levels associate with adverse outcomes in critically ill patients.

Methods

Multicenter observational study utilizing blood samples of critically ill patients (KLAKI) and patients undergoing cardiac surgery (TRIBE-AKI). Renin was measured by ELISA in serum from 296 critically ill patients at 24-48 h of AKI diagnosis (KDIGO ≥2) or ICU admission (controls), and perioperatively in plasma from 105 patients undergoing cardiac surgery (35 with AKI [≥0.3 mg/dL increase or ≥50% increase in serum creatinine from baseline preoperative level to postoperative level] and 70 controls without AKI). The association of renin levels with hospital mortality and major adverse kidney events at hospital discharge (MAKE: composite of death, need of renal replacement therapy or inability to recover more than 75% of baseline eGFR) was evaluated in the critically ill group.

Results

Renin levels were higher in critically ill patients with AKI vs. ICU controls without AKI (median [IQR], 67.9 [21.7-343.7] vs 22.2 [6.4-73.0] pg/mL, p<0.001). Similarly, patients undergoing cardiac surgery who developed postoperative AKI had pre and postoperative renin levels differentially higher than those without AKI, sustained from POD1 to POD3 (157.9 [80.0-390.8] vs. 68.9 [20.6-149.9] pg/mL at POD1 in AKI vs. no AKI, p=0.003). In adjusted models, higher renin levels independently associated with increased risk of hospital mortality (OR: 1.27, 95%CI: 1.02-1.58 for every 1-unit increase in renin and OR: 3.44, 95%CI: 1.08-11.02 when the highest tertile was compared to the lowest tertile). Further, every 1-unit increase in renin increased the risk of MAKE by 16% (95%CI: 1-33%).

Conclusion

Renin levels are differentially higher in patients with heterogeneous AKI when compared to controls without AKI. Renin levels associate with hospital mortality and MAKE in critically ill patients and therefore its utility in risk-stratification should be further explored in this vulnerable population.