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Kidney Week

Abstract: PO0244

Urinary Epidermal Growth Factor and CKD Progression: The ASSESS-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
  • Thiessen Philbrook, Heather, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
  • Hu, David G., Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
  • Obeid, Wassim, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
  • Bhatraju, Pavan K., University of Washington, Seattle, Washington, United States
  • Ikizler, Talat Alp, Vanderbilt University School of Medicine, Nashville, Tennessee, United States
  • Siew, Edward D., Vanderbilt University School of Medicine, Nashville, Tennessee, United States
  • Chinchilli, Vernon M., Penn State College of Medicine, Hershey, Pennsylvania, United States
  • Garg, Amit X., Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada
  • Go, Alan S., University of California San Francisco, San Francisco, California, United States
  • Liu, Kathleen D., University of California San Francisco, San Francisco, California, United States
  • Kaufman, James S., New York University Grossman School of Medicine, New York, New York, United States
  • Kimmel, Paul L., National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, United States
  • Himmelfarb, Jonathan, University of Washington, Seattle, Washington, 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

  • ASSESS-AKI Consortium
Background

Acute kidney injury (AKI) and chronic kidney disease (CKD) are interconnected syndromes with AKI recognized as a risk factor for CKD incidence or progression. However, biomarkers of repair or resilience, such as epidermal growth factor (EGF), may help better inform this risk, given the limitations of serum creatinine (sCr) in the setting of AKI.

Methods

We enrolled 1,538 hospitalized patients prospectively in the multi-center Assessment, Serial Evaluation, and Subsequent Sequelae of Acute Kidney Injury (ASSESS-AKI) Study. We measured urinary epidermal growth factor (uEGF) from samples at 3 months post-discharge. The primary outcome was a composite of CKD incidence, progression, or development of end-stage kidney disease (ESKD). We also evaluated change in estimated glomerular filtration rate (eGFR) over time by EGF quartile.

Results

299 (20%) patients developed the primary outcome at a median of 4.3 years follow-up. Patients in the fourth quartile of uEGF had higher eGFR at baseline and at 3-month follow-up compared to those in quartiles 1-3, as well as significantly lower albuminuria. Each 2-fold higher uEGF level was significantly associated with decreased risk of the composite outcome (HR 0.65; 95% CI: 0.59-0.71). This association remained robust after adjustment for demographic factors, baseline kidney function, urinary albumin, and other urinary biomarkers of injury and inflammation (aHR 0.65, 95% CI: 0.54-0.79). Patients in uEGF quartile 1 had the fastest decline in eGFR (-5.6% per year), compared to patients in uEGF quartiles 2-4 (-3.2, -2.8, -2.3% per year, respectively).

Conclusion

Urinary EGF is a marker of repair after kidney injury, and higher levels of uEGF after discharge are associated with reduced risk of CKD and progression to ESKD in hospitalized patients with and without AKI.

Funding

  • NIDDK Support