Faeq Husain-Syed1, Fiorenza Ferrari2, Aashish Sharma2, Tommaso Hinna Danesi3, Pércia Bezerra2, Salvador Lopez-Giacoman2, Sara Samoni2, Massimo de Cal4, Valentina Corradi4, Grazia Maria Virzì4, Silvia De Rosa2, María Jimena Muciño Bermejo2, Carla Estremadoyro2, Gianluca Villa2, Jose J Zaragoza2, Carlotta Caprara2, Alessandra Brocca2, Horst-Walter Birk5, Hans-Dieter Walmrath5, Werner Seeger5, Federico Nalesso6, Monica Zanella6, Alessandra Brendolan4, Davide Giavarina7, Loris Salvador3, Rinaldo Bellomo8, Mitchell H Rosner9, John A Kellum10, Claudio Ronco11. 1. 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, Giessen, Germany. 2. International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy. 3. Department of Cardiac Surgery, San Bortolo Hospital, Vicenza, Italy. 4. International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy; Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy. 5. Department of Internal Medicine II, Division of Pulmonology, Nephrology and Critical Care Medicine, University Clinic Giessen and Marburg, Giessen, Germany. 6. Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy. 7. Department of Clinical Chemistry and Hematology Laboratory, San Bortolo Hospital, Vicenza, Italy. 8. Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia; Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. 9. Department of Medicine, University of Virginia Health System, Charlottesville, Virginia. 10. Center for Critical Care Nephrology, CRISMA, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. 11. International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy; Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy. Electronic address: cronco@goldnet.it.
Abstract
BACKGROUND: Although acute kidney injury (AKI) frequently complicates cardiac operations, methods to determine AKI risk in patients without underlying kidney disease are lacking. Renal functional reserve (RFR) can be used to measure the capacity of the kidney to increase glomerular filtration rate under conditions of physiologic stress and may serve as a functional marker that assesses susceptibility to injury. We sought to determine whether preoperative RFR predicts postoperative AKI. METHODS: We enrolled 110 patients with normal resting glomerular filtration rates undergoing elective cardiac operation. Preoperative RFR was measured by using a high oral protein load test. The primary end point was the ability of preoperative RFR to predict AKI within 7 days of operation. Secondary end points included the ability of a risk prediction model, including demographic and comorbidity covariates, RFR, and intraoperative variables to predict AKI, and the ability of postoperative cell cycle arrest markers at various times to predict AKI. RESULTS: AKI occurred in 15 patients (13.6%). Preoperative RFR was lower in patients who experienced AKI (p < 0.001) and predicted AKI with an area under the receiver operating characteristic curve (AUC) of 0.83 (95% confidence interval [CI]: 0.70 to 0.96). Patients with preoperative RFRs not greater than 15 mL · min-1 · 1.73 m-2 were 11.8 times more likely to experience AKI (95% CI: 4.62 to 29.89 times, p < 0.001). In addition, immediate postoperative cell cycle arrest biomarkers predicted AKI with an AUC of 0.87. CONCLUSIONS: Among elective cardiac surgical patients with normal resting glomerular filtration rates, preoperative RFR was highly predictive of AKI. A reduced RFR appears to be a novel risk factor for AKI, and measurement of RFR preoperatively can identify patients who are likely to benefit from preventive measures or to select for use of biomarkers for early detection. Larger prospective studies to validate the use of RFR in strategies to prevent AKI are warranted. ClinicalTrials.gov identifier: NCT03092947, ISRCTN Registry: ISRCTN16109759.
BACKGROUND: Although acute kidney injury (AKI) frequently complicates cardiac operations, methods to determine AKI risk in patients without underlying kidney disease are lacking. Renal functional reserve (RFR) can be used to measure the capacity of the kidney to increase glomerular filtration rate under conditions of physiologic stress and may serve as a functional marker that assesses susceptibility to injury. We sought to determine whether preoperative RFR predicts postoperative AKI. METHODS: We enrolled 110 patients with normal resting glomerular filtration rates undergoing elective cardiac operation. Preoperative RFR was measured by using a high oral protein load test. The primary end point was the ability of preoperative RFR to predict AKI within 7 days of operation. Secondary end points included the ability of a risk prediction model, including demographic and comorbidity covariates, RFR, and intraoperative variables to predict AKI, and the ability of postoperative cell cycle arrest markers at various times to predict AKI. RESULTS: AKI occurred in 15 patients (13.6%). Preoperative RFR was lower in patients who experienced AKI (p < 0.001) and predicted AKI with an area under the receiver operating characteristic curve (AUC) of 0.83 (95% confidence interval [CI]: 0.70 to 0.96). Patients with preoperative RFRs not greater than 15 mL · min-1 · 1.73 m-2 were 11.8 times more likely to experience AKI (95% CI: 4.62 to 29.89 times, p < 0.001). In addition, immediate postoperative cell cycle arrest biomarkers predicted AKI with an AUC of 0.87. CONCLUSIONS: Among elective cardiac surgical patients with normal resting glomerular filtration rates, preoperative RFR was highly predictive of AKI. A reduced RFR appears to be a novel risk factor for AKI, and measurement of RFR preoperatively can identify patients who are likely to benefit from preventive measures or to select for use of biomarkers for early detection. Larger prospective studies to validate the use of RFR in strategies to prevent AKI are warranted. ClinicalTrials.gov identifier: NCT03092947, ISRCTN Registry: ISRCTN16109759.
Authors: Federico Nalesso; Leda Cattarin; Laura Gobbi; Antonio Fragasso; Francesco Garzotto; Lorenzo Arcangelo Calò Journal: Int J Nephrol Renovasc Dis Date: 2020-04-24
Authors: Gianluca Villa; Silvia De Rosa; Caterina Scirè Calabrisotto; Alessandro Nerini; Thomas Saitta; Dario Degl'Innocenti; Laura Paparella; Vittorio Bocciero; Marco Allinovi; Angelo R De Gaudio; Marlies Ostermann; Stefano Romagnoli Journal: Perioper Med (Lond) Date: 2021-05-25
Authors: Peter Pickkers; Michael Darmon; Eric Hoste; Michael Joannidis; Matthieu Legrand; Marlies Ostermann; John R Prowle; Antoine Schneider; Miet Schetz Journal: Intensive Care Med Date: 2021-07-02 Impact factor: 17.440