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Abstract: FR-PO071

CCL14 Predicts Response to Diuretics in Patients With Moderate to Severe AKI

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology‚ Risk Factors‚ and Prevention

Authors

  • Demirjian, Sevag, Cleveland Clinic, Cleveland, Ohio, United States
  • Chawla, Lakhmir S., Veterans affairs, San Diego, California, United States
  • Hoste, Eric, Universiteit Gent, Gent, Belgium
  • Kampf, Patrick, Astute Medical Inc, San Diego, California, United States
  • Koyner, Jay L., University of Chicago, Chicago, Illinois, United States
  • McPherson, Paul, Astute Medical Inc, San Diego, California, United States
  • Kellum, John A., University of Pittsburgh, Pittsburgh, Pennsylvania, United States
Background

Non-recovery in patients with moderate to severe acute kidney injury (AKI) is associated with morbidity and mortality. Elevated CCL14 levels predict persistent AKI and might facilitate better patient management. We examined whether there is an interaction between CCL14 and diuretic use on urine output in order to guide subsequent volume management.

Methods

We analyzed data on 497 patients enrolled in 2 prior studies where urine output was documented the day prior, and two days following CCL14 measurement. Diuretic use was defined as any diuretic exposure from one day prior to one day following the CCL14 measurement. Urine output was compared across previously reported three categories of CCL14 (</=1.3, >1.3-13, >13 ng/mL) and by diuretic status using Tukey’s honestly significant difference test.

Results

In the overall cohort 242 (49%) patients received diuretics; 55%, 46% and 34% in patients with low, intermediate and high CCL14 levels, respectively. Urine output over 72 hours was greater with diuretics when CCL14 was low (</= 1.3 ng/mL) (difference in means (95%CI) = 2596 ml (1157 – 4034) ml, p= < .001), but not when CCL14 was elevated (Figure).

Conclusion

Response to diuretics was only observed in patients with low CCL14 (</=1.3 ng/mL) corresponding to low risk for persistent AKI. Identifying patients with AKI who are unlikely to respond to diuretics may guide clinicians at the bedside to choose alternative means for volume management.

 No diuretic use(n=255)Diuretics Use (n=242)p value
Male150 (59%)154 (64%)0.311
Age (years)64 (55 - 72)67 (57 - 75)0.038
Chronic kidney disease36 (14%)40 (17%)0.458
Diabetes mellitus82 (32%)91 (38%)0.221
Heart failure37 (15%)73 (30%)<0.001
Baseline serum creatinine (mg/dL)1.0 (0.7 - 1.2)1.0 (0.8 - 1.3)0.026
Non-renal APACHE III score at enrollment56 (40 - 75)55 (44 - 76)0.168
Fluid balance1 (mL) on Day 13234 (1477 - 6328)2122 (319 - 4282)<0.001
CCL14 concentration1 (ng/mL)2.17 (0.77 - 7.07)1.28 (0.56 - 4.60)0.004

Funding

  • Commercial Support