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Abstract: TH-PO032

Urine TIMP-2*IGFBP7 Compared With Traditional Parameters for Predicting Hemodialysis Termination in AKI: A Prospective Observational Study

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical‚ Outcomes‚ and Trials

Authors

  • Suttayamook, Teeraporn, Bhumibol Adulyadej Hospital, Bangkok, Bangkok, Thailand
  • Gojaseni, Pongsathorn, Bhumibol Adulyadej Hospital, Bangkok, Bangkok, Thailand
Background

Currently, there is no official guideline or protocol for when to stop intermittent kidney replacement therapy (IKRT) in acute kidney injury (AKI). The decision to stop IKRT was based on clinical perspectives and nephrologists' experiences. The urinary cell cycle arrest biomarkers tissue inhibitor of metalloproteinase-2 (TIMP2) and insulin-like growth factor binding protein-7 (IGFBP7) have good performance in risk prediction of AKI and there is some evidence for predicting renal recovery. Thus, this study aimed to explore the association between successful IKRT discontinuation and urinary TIMP2*IGFBP7, compared with other traditional parameters.

Methods

We prospectively enrolled medical and surgical patients who were diagnosed with AKI based on KDIGO 2012 criteria and required IKRT at Bhumibol Adulyadej Hospital, Bangkok, Thailand from July 2021 to January 2022. TIMP2*IGFBP7 and other clinical parameters were collected before each IKRT which potential to be the last session. The primary outcome was successful IKRT discontinuation for 14 days.

Results

Seventeen patients (age 68.35 ± 17.60) with thirty-nine AKI sessions were enrolled in the study. Of 39 IKRT sessions, 8 (20.51%) were able to terminate from IKRT for 14 days. We have found a non-significant association between urinary TIMP2*IGFBP7 and successful IKRT discontinuation with an area under the receiver operating characteristic curve (AUC) 0.55 [95% confidential interval (CI) 0.32-0.77, P=0.66]. On the other hand, 24-hour pre-IKRT urine volume showed the fair performance to predict an ability for successful IKRT discontinuation with an AUC of 0.76 [95% CI 0.56-0.96, P=0.023] with optimal cut point >1,478 ml/day (Youden’s index 0.49).

Conclusion

We have found no association between pre-IKRT urine TIMP2*IGFBP7 and successful IKRT discontinuation at 14 days, while 24 hours pre-IKRT urine output showed a fair predictive performance. Thus, clinical perspectives still play an important role in deciding to stop IKRT.

Funding

  • Government Support – Non-U.S.