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Abstract: SA-PO122

Intra-Operative Shedding of Endothelial Glycocalyx in Cardiac Surgery-Associated AKI: A Prospective Longitudinal Cohort

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Joslin, Jennifer R., King's College London, London, United Kingdom
  • Deshpande, Ranjit, Cardiothoracic Surgery, King's College Hospital, London, United Kingdom
  • Griffiths, Kathryn, King's College London, London, United Kingdom
  • Satchell, Simon C., University of Bristol, Bristol, Bristol, United Kingdom
  • Sharpe, Claire C., King's Kidney Care, King's College Hospital, London, United Kingdom
  • Bramham, Kate, King's College London, London, United Kingdom
Background

This novel study aimed to consider the temporal association between microvascular disruption and cardiac surgery-associated acute kidney injury (CSA-AKI) by investigating dynamic endothelial glycocalyx changes.

Methods

We conducted a prospective observational cohort study of 61 patients undergoing non-emergency coronary artery bypass graft (CABG) surgery with serial sampling at set time-points in the pre, intra and post-operative period. We measured plasma syndecan-1 (SDC1), a major endothelial glycocalyx structural component, and calculated a ratio against plasma albumin (SDC1:alb) to take account of intraoperative haemodilution fluctuations. CSA-AKI within 48 hours was assessed using Kidney Disease Improving Global Outcomes (KDIGO) criteria. Demographic, clinical and surgical variables were considered in analysis.

Results

14/61 (23.0%) participants developed CSA-AKI.
Peak intraoperative SDC1:alb and increase from baseline of peak SDC1:alb were significantly higher in participants who subsequently developed CSA-AKI compared to those who did not (P=0.0063; P=0.008). (Figure 1)
The best predictor variables of CSA-AKI were peak SDC1:alb (AUC 0.777) and urine protein:creatinine ratio (uPCR, AUC 0.840).
After adjusting for uPCR and other key variables, odds of CSA-AKI in patients with peak SDC1:alb greater than the derived optimal cut-off of 23 were 11 times those with a lower peak SDC1:alb (OR 11.0 (95% CI 1.57- 106.91, P=0.021)).

Conclusion

This is the first demonstration of increased intraoperative shedding of SDC1, a core endothelial glycocalyx constituent, in CABG patients who subsequently developed CSA-AKI. These findings suggest endothelial glycocalyx disruption and microvascular dysfunction in CSA-AKI may provide a target for early therapeutic intervention and / or facilitate earlier identification of patients at greatest risk.