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Kidney Week

Abstract: PO0243

Serum Renin and Major Adverse Kidney Events in Critically Ill Patients: A Multicenter Prospective Study

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Flannery, Alexander H., University of Kentucky College of Pharmacy, Lexington, Kentucky, United States
  • Ortiz-Soriano, Victor M., University of Kentucky College of Medicine, Lexington, Kentucky, United States
  • Li, Xilong, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
  • Gianella, Fabiola, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
  • Toto, Robert D., The University of Texas Southwestern Medical Center, Dallas, Texas, United States
  • Moe, Orson W., The University of Texas Southwestern Medical Center, Dallas, Texas, United States
  • Devarajan, Prasad, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Goldstein, Stuart, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Neyra, Javier A., University of Kentucky College of Medicine, Lexington, Kentucky, United States
Background

Preliminary studies have suggested that the renin-angiotensin system (RAS) is activated in critical illness and associated with mortality and adverse kidney outcomes. We sought to assess in a larger, multicenter study the relationship between serum renin and Major Adverse Kidney Events (MAKE) in intensive care unit (ICU) patients.

Methods

Prospective, multicenter study at two institutions of patients with and without acute kidney injury (AKI). Blood samples were collected for renin measurement a median of 2 days into the index ICU admission (T1) and 5-7 days later (T2). The primary outcome was MAKE at hospital discharge, a composite of mortality, kidney replacement therapy, or reduced estimated glomerular filtration rate to ≤ 75% of baseline.

Results

Two hundred and eighty patients were enrolled with available blood samples for analysis. Patients in the highest renin tertile were more severely ill overall, and serum renin was significantly higher at both time points in patients with AKI, those who experienced MAKE, and those who died (Fig. 1). In multivariable logistic regression, this initial measurement of renin (T1) was significantly associated with MAKE: third renin tertile OR 2.33 (95% CI 1.01-5.44) and second renin tertile OR 2.51 (1.08-5.80) in reference to the first renin tertile. Similar results were noted for renin's association with hospital mortality. The association of renin with MAKE events in survivors was not statistically significant. The trajectory of the renin measurements between T1 and T2 was distinct when comparing death vs. survival, but not when comparing MAKE vs. those without.

Conclusion

In a broad cohort of critically ill patients, serum renin measured early in the ICU admission is associated with MAKE events at discharge, particularly mortality.

Serum renin in patients with and without AKI, MAKE, and mortality.

Funding

  • NIDDK Support