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Title: Persistent decrease of renal functional reserve in patients after cardiac surgery-associated acute kidney injury despite clinical recovery.
Austin Authors: Husain-Syed, Faeq;Ferrari, Fiorenza;Sharma, Aashish;Hinna Danesi, Tommaso;Bezerra, Pércia;Lopez-Giacoman, Salvador;Samoni, Sara;de Cal, Massimo;Corradi, Valentina;Virzì, Grazia Maria;De Rosa, Silvia;Muciño Bermejo, María Jimena;Estremadoyro, Carla;Villa, Gianluca;Zaragoza, Jose J;Caprara, Carlotta;Brocca, Alessandra;Birk, Horst-Walter;Walmrath, Hans-Dieter;Seeger, Werner;Nalesso, Federico;Zanella, Monica;Brendolan, Alessandra;Giavarina, Davide;Salvador, Loris;Bellomo, Rinaldo ;Rosner, Mitchell H;Kellum, John A;Ronco, Claudio
Affiliation: International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
Department of Internal Medicine II, Division of Pulmonology, Nephrology and Critical Care Medicine, University Clinic Giessen and Marburg-Campus Giessen, Giessen, Germany
Department of Clinical Chemistry and Hematology Laboratory, San Bortolo Hospital, Vicenza, Italy
Department of Cardiac Surgery, San Bortolo Hospital, Vicenza, Italy
Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA
Department of Critical Care Medicine, Center for Critical Care Nephrology, CRISMA, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
Issue Date: 2019
Date: 2018-07-19
Publication information: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association 2019; 34(2): 308-317
Abstract: Cardiac surgery is a leading cause of acute kidney injury (AKI). Such AKI patients may develop progressive chronic kidney disease (CKD). Others, who appear to have sustained no permanent loss of function (normal serum creatinine), may still lose renal functional reserve (RFR). We extended the follow-up in the observational 'Preoperative RFR Predicts Risk of AKI after Cardiac Surgery' study from hospital discharge to 3 months after surgery for 86 (78.2%) patients with normal baseline estimated glomerular filtration rate (eGFR), and re-measured RFR with a high oral protein load. The primary study endpoint was change in RFR. Study registration at Identifier: NCT03092947, ISRCTN Registry: ISRCTN16109759. At 3 months, three patients developed new CKD. All remaining patients continued to have a normal eGFR (93.3 ± 15.1 mL/min/1.73 m2). However, when stratified by post-operative AKI and cell cycle arrest (CCA) biomarkers, AKI patients displayed a significant decrease in RFR {from 14.4 [interquartile range (IQR) 9.5 - 24.3] to 9.1 (IQR 7.1 - 12.5) mL/min/1.73 m2; P < 0.001} and patients without AKI but with positive post-operative CCA biomarkers also experienced a similar decrease of RFR [from 26.7 (IQR 22.9 - 31.5) to 19.7 (IQR 15.8 - 22.8) mL/min/1.73 m2; P < 0.001]. In contrast, patients with neither clinical AKI nor positive biomarkers had no such decrease of RFR. Finally, of the three patients who developed new CKD, two sustained AKI and one had positive CCA biomarkers but without AKI. Among elective cardiac surgery patients, AKI or elevated post-operative CCA biomarkers were associated with decreased RFR at 3 months despite normalization of serum creatinine. Larger prospective studies to validate the use of RFR to assess renal recovery in combination with biochemical biomarkers are warranted.
DOI: 10.1093/ndt/gfy227
ORCID: 0000-0002-1650-8939
Journal: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
PubMed URL: 30053231
Type: Journal Article
Appears in Collections:Journal articles

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