Abstract: TH-PO0748
Kidney Clearance of Secretory Solutes at Intensive Care Unit (ICU) Admission Is Associated with Major Adverse Kidney Events at 30 Days
Session Information
- AKI: Critical Care, CKRT, Cardiorenal Syndromes, and Clinical Outcomes
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Hatten-Beck, Maya, University of Washington, Seattle, Washington, United States
- Bhatraju, Pavan K., University of Washington, Seattle, Washington, United States
- Siew, Edward D., Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Kestenbaum, Bryan R., University of Washington, Seattle, Washington, United States
Background
Most causes of acute kidney injury (AKI) involve the proximal tubules. Yet, current assessment of AKI is based on serum creatinine, a marker of the glomerular filtration rate (GFR). We developed a novel assay to quantify tubular secretory clearance, and we determined associations with major adverse kidney events (MAKE) in a prospective study of critical illness.
Methods
We evaluated 246 critically ill adults enrolled in the Role of Kidney Tubular Secretion in Critical Illness cohort. We used a targeted mass spectroscopy assay to measure plasma and four-hour timed urine concentrations of 10 endogenous secretory solutes at ICU admission. We calculated the kidney clearance of each solute as (Ux / Px) * V, where Ux and Px represent urine and plasma concentrations of each solute and V represents timed urine volume. We standardized secretory clearances to a common 0-100 scale based on normative values. We defined MAKE by either a doubling of the baseline serum creatinine concentration, dialysis dependence, or death at hospital discharge or 30-days. We used logistic regression to test associations of secretory clearances with the MAKE outcome.
Results
The median age was 58 years and median admission creatinine concentration was 1.0 mg/dL. 28 participants (11%) developed MAKE over follow-up. In univariate analyses, lower clearances of all 10 secretory solutes were associated with a significantly higher odds of MAKE. After adjustment for age, sex, SOFA score, admission creatinine, and creatinine clearance measured in the same timed urine sample, lower clearances of all secretory solutes remained associated with a significantly higher odds of MAKE (Figure 1).
Conclusion
The assessment of tubular secretory clearance in critically ill patients provides important information about kidney prognosis beyond estimates of GFR.
Funding
- NIDDK Support