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Kidney Week

Abstract: PO0246

Preoperative Plasma TNFR1, TNFR2, and KIM-1 and Long-Term Adverse Events After Cardiac Surgery: The TRIBE-AKI Study

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Vasquez-Rios, George, Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Moledina, Dennis G., Yale University School of Medicine, New Haven, Connecticut, United States
  • McArthur, Eric, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
  • Mansour, Sherry, Yale University School of Medicine, New Haven, Connecticut, United States
  • Menez, Steven, Johns Hopkins University, Baltimore, Maryland, United States
  • Thiessen Philbrook, Heather, Johns Hopkins University, Baltimore, Maryland, United States
  • Shlipak, Michael, University of California San Francisco, San Francisco, California, United States
  • Koyner, Jay L., University of Chicago Pritzker School of Medicine, Chicago, Illinois, United States
  • Garg, Amit X., London Health Sciences Centre, London, Ontario, Canada
  • Parikh, Chirag R., Johns Hopkins University, Baltimore, Maryland, United States
  • Coca, Steven G., Icahn School of Medicine at Mount Sinai, New York, New York, United States

Group or Team Name

  • TRIBE-AKI Consortium
Background

Plasma TNFR1, TNFR2, and KIM-1 have been associated with CKD progression in ambulatory patients with/without diabetes. However, their role as predictors of long-term outcomes and their ability to discriminate such outcomes compared to clinical parameters prior to cardiac surgery is unknown.

Methods

Prospective, multicenter cohort study of high-risk adults undergoing cardiac surgery (2007-2010). We assessed the association between pre-operative levels of TNFR1, TNFR2, and KIM-1 (natural log-transformed) and long-term mortality, CKD (incidence/progression), and cardiovascular (CV) events. We also examined the potential effect modification of DM status on the relationship between these biomarkers and outcomes. C-statistic analysis was used to quantify the discriminatory ability of the biomarkers beyond the clinical model.

Results

1378 participants (69.1% male) with a mean age: 71.9 ± 9.7, were followed for a median of 5.6 (IQR 4.3-8.6) years. 434 (31.5%) died within the study timeframe, 251 (30%) developed CKD, & 256 (19%) had CV events. After adjustment for covariates, each natural log increase in biomarker concentration was associated with mortality [adjusted HR: TNFR1, 3.0 (95% CI 2.3-4.0); TNFR2, 2.3 (95% CI 1.8-2.9); KIM-1, 2.0 (95% CI 1.6-2.4)]. Similar effect sizes were seen for all 3 biomarkers in their association with CV & CKD events (Figure 1). Baseline DM status did not modify the association between biomarkers and clinical outcomes. The addition of all 3 biomarkers improved discrimination for the 3 outcomes.

Conclusion

Preoperative plasma TNFR1, TNFR2, and KIM-1 were independently associated with long-term outcomes after cardiac surgery and improved discrimination compared to standard clinical models. Pre-operative plasma biomarkers may serve with timely risk-stratification and planning to prevent clinical sequela.

HRs were adjusted for age, sex, race, pre-op clinical & kidney-related parameters.

Funding

  • Other NIH Support