Kidney Week

Abstract: FR-PO0062

Tubular Stress Markers and Future Risk of Sepsis-Associated AKI

Session Information

• AKI: Epidemiology, Risk Factors, and Prevention
  November 07, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

• Lee, Adrian, University of California San Diego, La Jolla, California, United States

Adrian Lee

• Katz, Ronit, University of Washington, Seattle, Washington, United States

Ronit Katz, PhD

• Wong, Angela, University of California San Diego, La Jolla, California, United States

Angela Wong

• Guerrero, Felipe, Oakland University, Rochester, Michigan, United States

Felipe Guerrero

• Vaingankar, Sucheta M., University of California San Diego, La Jolla, California, United States

Sucheta M. Vaingankar, PhD

• Wettersten, Nicholas, VA San Diego Healthcare System, San Diego, California, United States

Nicholas Wettersten, MD

• Judd, Suzanne E., University of Alabama at Birmingham Health System, Birmingham, Alabama, United States

Suzanne E. Judd, PhD

• Shlipak, Michael, San Francisco VA Health Care System, San Francisco, California, United States

Michael Shlipak, MD, MPH

• Gutierrez, Orlando M., University of Alabama at Birmingham Health System, Birmingham, Alabama, United States

Orlando M. Gutierrez, MD

• Bullen, Alexander L., VA San Diego Healthcare System, San Diego, California, United States

Alexander L. Bullen, MD, FASN

Background

Sepsis is one of the leading causes of death worldwide, particularly when it is complicated with acute kidney injury (AKI). Urinary tissue inhibitor of metalloproteinases-2 (TIMP-2) and insulin-like growth factor binding protein-7 (IGFBP7) are tubular stress markers shown to be early markers of AKI. We investigated the performance of both markers in identifying future risk of sepsis-associated AKI.

Methods

We performed a case-control study among participants who provided urine at the baseline visit in REGARDS, a population-based cohort study. Each septic AKI case by age, sex, race, and time from baseline to hospital admission 1:1 to a participant with sepsis who did not develop AKI (controls). Using conditional logistic regression, we evaluated the associations of TIMP-2, IGFBP7, and their product with the risk of septic AKI.

Results

Among 450 participants, mean age was 69 years, 44% were female, and 39% were Black participants. Median baseline eGFR among cases and controls was 73 and 82 mL/min/1.73m², and median albuminuria was 19 vs. 9 mg/g, respectively. Mean follow-up was 4.3 years. IGFBP7 was associated with future risk of septic AKI after adjusting for baseline eGFR, albuminuria, and other risk factors (OR: 1.24, 95% CI [1.02, 1.52]). TIMP2 was not associated with septic AKI.

Conclusion

Among community participants, higher tubular stress is associated with risk of septic AKI independent of baseline eGFR and albuminuria.

Table. Association of biomarkers (per 2-fold higher) with risk of septic acute kidney injury

*Adjusted for urine creatinine, diabetes mellitus, systolic blood pressure, baseline eGFR, and urine albumin

Funding

• NIDDK Support

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025ngdsw061