Background: 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). Methods: 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 clinicaltrials.gov Identifier: NCT03092947, ISRCTN Registry: ISRCTN16109759. Results: 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. Conclusions: 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.
Background: 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). Methods: 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 clinicaltrials.gov Identifier: NCT03092947, ISRCTN Registry: ISRCTN16109759. Results: 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. Conclusions: 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.
Authors: Chi-Yuan Hsu; Raymond K Hsu; Kathleen D Liu; Jingrong Yang; Amanda Anderson; Jing Chen; Vernon M Chinchilli; Harold I Feldman; Amit X Garg; Lee Hamm; Jonathan Himmelfarb; James S Kaufman; John W Kusek; Chirag R Parikh; Ana C Ricardo; Sylvia E Rosas; Georges Saab; Daohang Sha; Edward D Siew; James Sondheimer; Jonathan J Taliercio; Wei Yang; Alan S Go Journal: J Am Soc Nephrol Date: 2019-06-24 Impact factor: 10.121
Authors: Michael Joannidis; Lui G Forni; Michael Haase; Jay Koyner; Jing Shi; Kianoush Kashani; Lakhmir S Chawla; John A Kellum Journal: Crit Care Med Date: 2019-10 Impact factor: 7.598
Authors: Xiaoyan Wen; Shengnan Li; Alicia Frank; Xiukai Chen; David Emlet; Neil A Hukriede; John A Kellum Journal: Intensive Care Med Exp Date: 2020-02-07
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: Steven Menez; Wenjun Ju; Rajasree Menon; Dennis G Moledina; Heather Thiessen Philbrook; Eric McArthur; Yaqi Jia; Wassim Obeid; Sherry G Mansour; Jay L Koyner; Michael G Shlipak; Steven G Coca; Amit X Garg; Andrew S Bomback; John A Kellum; Matthias Kretzler; Chirag R Parikh Journal: JCI Insight Date: 2021-06-08