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Abstract: PO0202

Markers of Kidney Tubule Cell Function and Future Risk of Infection-Associated AKI

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention


  • Bullen, Alexander, VA San Diego Healthcare System, San Diego, California, United States
  • Gutierrez, Orlando M., The University of Alabama at Birmingham School of Medicine Huntsville, Huntsville, Alabama, United States
  • Rifkin, Dena E., VA San Diego Healthcare System, San Diego, California, United States
  • Ix, Joachim H., VA San Diego Healthcare System, San Diego, California, United States

Novel biomarkers can quantify kidney tubular functions including proximal tubule reabsorption (alpha 1 microglobulin [a1m]), and tubule protein synthesis (uromodulin [umod]). We have previously reported that abnormalities in these markers at times of health predicted future risk of AKI secondary to volume depletion. Association between tubular function markers and other causes of AKI are uncertain.


We identified 474 individuals within the REGARDS study who had in-patient admissions for infections and developed AKI (≥ KDIGO stage 1) during 3.8 years follow-up. Cases were matched (1:1) by age, sex, race, and time from baseline to hospital admission to individuals admitted with infection but without AKI. We used stored urine specimens from REGARDS baseline to measure a1m (ELISA) and umod (immunoassay), as well as NGAL (immunoassay) as a marker of tubule injury. Conditional logistic regression evaluated odds of AKI.


Mean age was 70 ± 8 years, 44% were female, 38% were black. Mean baseline eGFR among cases and controls was 71 and 78 mL/min/1.73m2, respectively and mean albuminuria was 241 vs. 69 mg/g, respectively. Cases were more likely to be taking ACEi, ARB, and NSAIDs. Most had state 1 AKI (92.7%). Higher urine a1m and higher urine umod levels were each associated with higher AKI risk but these associations were attenuated in final models. Results were similar with NGAL (Table). Results were also similar when examining KDIGO stage 2 or greater AKI vs. controls.


At times of health, urine a1m and UMOD are not independently associated with future risk of infection-associated AKI.


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