Christoph Reichetzeder1,2, Fabian Heunisch1,2,3, Gina von Einem1,3, Oleg Tsuprykov1,2,4, Karl-Heinz Kellner5, Thomas Dschietzig6,7, Axel Kretschmer8, Berthold Hocher1,4,9. 1. Institute of Nutritional Sciences, University of Potsdam, Nuthetal, Germany. 2. Center for Cardiovascular Research, Berlin, Germany. 3. Department of Nephrology, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany. 4. Institut für Laboratoriumsmedizin Berlin, IFLb, Berlin, Germany. 5. Neuroimmun GmbH, Karlsruhe, Germany. 6. Department of Cardiology and Angiology, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany. 7. Immundiagnostik AG, Bensheim, Germany. 8. Bayer AG, Wuppertal, Germany. 9. Department of Basic Medicine, Jinan University, Jinan, China.
Abstract
BACKGROUND/AIMS: Contrast induced acute kidney injury (CI-AKI) remains a serious complication of contrast media enhanced procedures like coronary angiography. There is still a lack of established biomarkers that help to identify patients at high risk for short and long-term complications. The aim of the current study was to evaluate plasma kynurenine as a predictive biomarker for CI-AKI and long-term complications, measured by the combined endpoint "major adverse kidney events" (MAKE) up to 120 days after CM application. METHODS: In this prospective cohort study 245 patients undergoing coronary angiography were analyzed. Blood samples were obtained at baseline, 24h and 48h after contrast media (CM) application to diagnose CI-AKI. Patients were followed for 120 days for adverse clinical events including death, the need for dialysis, and a doubling of plasma creatinine. Occurrence of any of these events was summarized in the combined endpoint MAKE. RESULTS: Preinterventional plasma kynurenine was not associated with CI-AKI. Patients who later developed MAKE displayed significantly increased preinterventional plasma kynurenine levels (p<0.0001). ROC analysis revealed that preinterventional kynurenine is highly predictive for MAKE (AUC=0.838; p<0.0001). The optimal cutoff was found at ≥3.5 µmol/L Using this cutoff, the Kaplan-Meier estimator demonstrated that concentrations of plasma kynurenine ≥3.5 µmol/L were significantly associated with a higher prevalence of MAKE until follow up (p<0.0001). This association remained significant in multivariate Cox regression models adjusted for relevant factors of long-term renal outcome. CONCLUSION: Preinterventional plasma kynurenine might serve as a highly predictive biomarker for MAKE up to 120 days after coronary angiography.
BACKGROUND/AIMS: Contrast induced acute kidney injury (CI-AKI) remains a serious complication of contrast media enhanced procedures like coronary angiography. There is still a lack of established biomarkers that help to identify patients at high risk for short and long-term complications. The aim of the current study was to evaluate plasma kynurenine as a predictive biomarker for CI-AKI and long-term complications, measured by the combined endpoint "major adverse kidney events" (MAKE) up to 120 days after CM application. METHODS: In this prospective cohort study 245 patients undergoing coronary angiography were analyzed. Blood samples were obtained at baseline, 24h and 48h after contrast media (CM) application to diagnose CI-AKI. Patients were followed for 120 days for adverse clinical events including death, the need for dialysis, and a doubling of plasma creatinine. Occurrence of any of these events was summarized in the combined endpoint MAKE. RESULTS: Preinterventional plasma kynurenine was not associated with CI-AKI. Patients who later developed MAKE displayed significantly increased preinterventional plasma kynurenine levels (p<0.0001). ROC analysis revealed that preinterventional kynurenine is highly predictive for MAKE (AUC=0.838; p<0.0001). The optimal cutoff was found at ≥3.5 µmol/L Using this cutoff, the Kaplan-Meier estimator demonstrated that concentrations of plasma kynurenine ≥3.5 µmol/L were significantly associated with a higher prevalence of MAKE until follow up (p<0.0001). This association remained significant in multivariate Cox regression models adjusted for relevant factors of long-term renal outcome. CONCLUSION: Preinterventional plasma kynurenine might serve as a highly predictive biomarker for MAKE up to 120 days after coronary angiography.
Authors: Luis F Somarribas Patterson; Soumya R Mohapatra; Dyah L Dewi; Christiane A Opitz; Ahmed Sadik; Michael Platten; Saskia Trump Journal: Br J Cancer Date: 2019-12-10 Impact factor: 7.640