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Abstract: TH-PO028

Changes in 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 School of Medicine, Seattle, Washington, United States
  • Ikizler, Talat Alp, Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Siew, Edward D., Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Garg, Amit X., Western University, London, Ontario, Canada
  • Chinchilli, Vernon M., Penn State College of Medicine, Hershey, Pennsylvania, United States
  • Go, Alan S., Kaiser Permanente Northern California, Oakland, California, United States
  • Liu, Kathleen D., University of California San Francisco School of Medicine, San Francisco, California, United States
  • Kaufman, James S., NYU Langone Health, 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 School of Medicine, 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 clear risk factor for CKD incidence or progression. However, biomarkers of repair and epithelial cell integrity of the distal tubule, such as urinary epidermal growth factor (uEGF), 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 uEGF from samples collected during hospitalization and at 3 months post-discharge. The primary outcome was a composite of major adverse kidney events (MAKE) consisting of CKD incidence, progression, or development of end-stage kidney disease.

Results

299 (20%) patients developed the primary outcome at a median of 4.3 years follow-up. In fully adjusted models, each 1-standard deviation increase in uEGF from hospitalization to 3 months was associated with a significantly decreased risk of the composite outcome (aHR 0.71; 95% CI: 0.54-0.94; Table 1). Patients in tertile 3 (increase in uEGF) had a significantly lower risk of MAKE (aHR 0.53; 95% CI: 0.36-0.78) compared to those in tertile 2, which included patients who had no improvement in uEGF. Similar results were seen in stratified analysis by AKI status at the time of hospitalization, suggesting subclinical disease in patients without AKI.

Conclusion

Urinary EGF is a marker of healthy repair after kidney injury, and increases in uEGF from hospitalization to discharge are associated with a decreased risk of MAKE in patients both with and without AKI.

Funding

  • NIDDK Support