Abstract: FR-PO133
Proenkephalin May Improve Strategies for Successful Weaning from RRT
Session Information
- AKI: Outcomes, RRT
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Nusshag, Christian, Heidelberg University Hospital Department of Nephrology, Heidelberg, Germany
- Gabriel, David, Heidelberg University Hospital Department of Nephrology, Heidelberg, Germany
- Grenz, Julia, Heidelberg University Hospital Department of Nephrology, Heidelberg, Germany
- Göth, Daniel, Heidelberg University Hospital Department of Nephrology, Heidelberg, Germany
- Benning, Louise, Heidelberg University Hospital Department of Nephrology, Heidelberg, Germany
- Schmitt, Felix C.F., Heidelberg University Hospital Department of Anesthesiology, Heidelberg, Germany
- Merle, Uta, Heidelberg University Hospital Department of Gastroenterology, Heidelberg, Germany
- Zeier, Martin G., Heidelberg University Hospital Department of Nephrology, Heidelberg, Germany
- Fiedler, Mascha O., Heidelberg University Hospital Department of Nephrology, Heidelberg, Germany
- Weigand, Markus A., Heidelberg University Hospital Department of Nephrology, Heidelberg, Germany
- Morath, Christian, Heidelberg University Hospital Department of Nephrology, Heidelberg, Germany
Group or Team Name
- Nusshag Lab.
Background
Acute kidney injury (AKI) is associated with fatal outcomes, particularly in patients requiring renal replacement therapy (RRT). Conventional kidney biomarkers such as serum creatinine (SCr) are incapable of indicating kidney recovery in patients receiving RRT. Proenkephalin A (penKid) is a novel kidney biomarker with unique characteristics. We hypothesized that penKid could provide a more accurate prediction of successful weaning from RRT than established standards of care.
Methods
Measurement of penKid plasma levels were implemented in the daily blood routine at our center. In this preliminary analysis, data of 1473 patients were gathered. The start of a weaning trial was defined as 48h without RRT, and weaning was considered successful if a patient did not require RRT for five consecutive days.
Results
RRT procedures were performed in 234 patients of whom 54 patients were chronically dependent on hemodialysis prior ICU admission. Baseline and maximum penKid levels showed a stepwise increase with rising AKI stage (KDIGO criteria). Median penKid levels at RRT start were 128.2 pmol/L and increased further under RRT. In contrast, SCr levels decreased in association with RRT procedures. In patients with pre-existing chronic RRT-dependency, penKid levels were significantly higher than in patients with acute RRT requirements at any time after RRT initiation (Day 3 after RRT Start: 134.7 vs. 403.9 pmol/L), while SCr was already indifferent on day 3 (1.60 vs. 1.49 mg/dL). Differing RRT modalities had no effect on penKid levels, whereas continuous RRT forms were more effective than intermittent RRT in clearing SCr. On the day of last RRT, the area under the curve (AUC) for predicting successful RRT weaning was higher for penKid compared to UO with 0.76 (95% CI 0.58-0.94, p=0.014) and 0.74 (95% CI 0.55-0.94, p=0.039), respectively. One day earlier, predictive performance was even more favorable for penKid compared to UO (AUC 0.72 [95% CI 0.54-0.91, p=0.036] vs. 0.58 [95% CI 0.36-0.80, p=0.879]).
Conclusion
Our data suggest that penKid may provide additional information to standard of care rgarding kidney integrity under RRT, making it a valuable biomarker to predict liberation from RRT. This has large clinical implications given the importance of avoiding unnecessary RRT-procedures.