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Abstract: PO0417

Hospitalized AKI Is Associated with Long-Term Increases in TNFR1 and TNFR2: Findings from the CRIC Study

Session Information

Category: Acute Kidney Injury

  • 103 AKI: Mechanisms

Authors

  • Mccoy, Ian, University of California San Francisco, San Francisco, California, United States
  • Hsu, Jesse Yenchih, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Bonventre, Joseph V., Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Parikh, Chirag R., Johns Hopkins University, Baltimore, Maryland, United States
  • Hsu, Chi-yuan, University of California San Francisco, San Francisco, California, United States
Background

Evaluation of plasma biomarkers before and after AKI may yield valuable insights into the pathogenesis of progressive CKD after AKI. Markers of endothelial inflammation and injury, Tumor Necrosis Factor Receptors 1 and 2 (TNFR1 and TNFR2), are associated with progressive CKD, but it is unknown whether an episode of hospitalized AKI may cause long-term changes in these biomarkers.

Methods

Among participants in the prospective Chronic Renal Insufficient Cohort (CRIC), episodes of hospitalized AKI were identified using acute changes in inpatient serum creatinine values (peak/nadir ≥1.5). For each AKI hospitalization, we found the best matched non-AKI hospitalization (unique patients) using the following pre-hospitalization criteria: estimated glomerular filtration rate (eGFR), urine protein/creatinine ratio, duration between hospital discharge and next CRIC visit (max 1 year), diabetes, age, sex, and duration between hospital admission and prior CRIC visit (max 2 years). We measured plasma levels of TNFR1 and TNFR2 using banked plasma samples collected at CRIC study visits before and after the hospitalization. Biomarkers were measured using a customized U-Plex assay on a MesoScale Device.

Results

Study participants who did and did not have AKI were well matched (Table). Pre-hospitalization TNFR1 and TNFR2 levels were also similar. AKI was associated with greater increases in TNFR1 (p<0.01) and TNFR2 (p<0.01).

Conclusion

Hospitalized AKI was associated with increases in plasma TNFR1 and TNFR2 months after the hospitalization.

Characteristics
Mean (std) or Median [IQR]
AKI Hospitalization
(n = 198)
Non-AKI Hospitalization
(n = 198)
Age, yrs66 (9)66 (9)
Female39%36%
Pre-hospitalization eGFR, mL/min/1.73m248 (17)48 (17)
Pre-hospitalization UPCR, g/g0.24 [0.10-0.99]0.26 [0.08-0.90]
Duration between prior CRIC visit and hospital admission, days221 [138-291]220 [123-283]
Ln(TNFR1 in pg/ml) pre- and post-hospitalization7.23 and 7.447.27 and 7.33
Change in TNFR-1 (Ln(pg/ml))0.21*0.06*
TNFR-2 (pg/mL) pre- and post-hospitalization50900 and 5725550101 and 52626
Change in TNFR-2 (pg/mL)6355*2525*

*P <0.05 comparing AKI vs. non-AKI.

Funding

  • NIDDK Support