Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/34374
Title: Reduced urinary levels of angiotensin-converting enzyme 2 activity predict acute kidney injury in critically ill patients.
Austin Authors: Bitker, Laurent;Patel, Sheila K ;Bittar, Intissar ;Eastwood, Glenn M ;Bellomo, Rinaldo ;Burrell, Louise M 
Affiliation: Intensive Care
Medicine (University of Melbourne)
Pathology
Centre for Integrated Critical Care, University of Melbourne, Melbourne, VIC, Australia.
Université de Lyon, Lyon, France.
Issue Date: Dec-2020
Date: 2023
Publication information: Critical Care and Resuscitation : Journal of the Australasian Academy of Critical Care Medicine 2020-12; 22(4)
Abstract: Objective: Angiotensin-converting enzyme 2 activity reflects non-classical renin-angiotensin system upregulation. We assessed the association of urinary angiotensin-converting enzyme 2 (uACE2) activity with acute kidney injury (AKI). Design, setting and participants: A prospective observational study in which we measured uACE2 activity in 105 critically ill patients at risk of AKI. We report AKI stage 2 or 3 at 12 hours of urine collection (AKI12h) and AKI stage 2 or 3 at any time during intensive care unit stay in patients free from any stage of AKI at inclusion (AKIICU). AKI prediction was assessed using area under the receiver-operating characteristics curve (AUROC) and net reclassification indices (NRIs). Main outcome measure: AKI stage 2 or 3 at 12 hours of urine collection. Results: Within 12 hours of inclusion, 32 of 105 patients (30%) had developed AKI12h. Corrected uACE2 activity was significantly higher in patients without AKI12h compared with those with AKI12h (median [interquartile range], 13 [6-24] v 7 [4-10] pmol/min/mL per mmol/L of urine creatinine; P < 0.01). A 10-unit increase in uACE2 was associated with a 28% decrease in AKI12h risk (odds ratio [95% CI], 0.72 [0.46-0.97]). During intensive care unit admission, 39 of 76 patients (51%) developed AKIICU. uACE2 had an AUROC for the prediction of AKI12h of 0.68 (95% CI, 0.57-0.79), and correctly reclassified 28% of patients (positive NRI) to AKI12h. Patients with uACE2 > 8.7 pmol/min/mL per mmol/L of urine creatinine had a significantly lower risk of AKIICU on log-rank analysis (52% v 84%; P < 0.01). Conclusions: Higher uACE2 activity was associated with a decreased risk of AKI stage 2 or 3. Our findings support future evaluations of the role of the non-classical renin-angiotensin system during AKI.
URI: https://ahro.austin.org.au/austinjspui/handle/1/34374
DOI: 10.51893/2020.4.OA7
ORCID: 
Journal: Critical Care and Resuscitation : Journal of the Australasian Academy of Critical Care Medicine
Start page: 344
End page: 354
PubMed URL: 38046883
Type: Journal Article
Appears in Collections:Journal articles

Show full item record

Page view(s)

22
checked on Oct 4, 2024

Google ScholarTM

Check


Items in AHRO are protected by copyright, with all rights reserved, unless otherwise indicated.