Outcome Prediction of Acute Kidney Injury Biomarkers at Initiation of Dialysis in Critical Units

被引:19
作者
Wu, Vin-Cent [1 ]
Shiao, Chih-Chung [2 ,3 ]
Chi, Nai-Hsin [4 ]
Wang, Chih-Hsien [4 ]
Chueh, Shih-Chieh Jeff [5 ]
Liou, Hung-Hsiang [6 ]
Spapen, Herbert D. [7 ]
Honore, Patrick M. [8 ]
Chu, Tzong-Shinn [1 ,9 ]
机构
[1] Natl Taiwan Univ Hosp, Div Nephrol, 7 Chung Shan South Rd, Taipei 100, Taiwan
[2] St Marys Hosp Luodong, Dept Internal Med, Div Nephrol, 160 Chong Cheng South Rd, Yilan 265, Taiwan
[3] Nursing & Management Coll, St Marys Jr Coll Med, 100,Ln 265,Sec 2,Sanxing Rd, Yilan 266, Taiwan
[4] Natl Taiwan Univ Hosp, Surg Dept, 7 Chung Shan South Rd, Taipei 100, Taiwan
[5] Cleveland Clin, Lerner Coll Med, Glickman Urol & Kidney Inst, 9500 Euclid Ave, Cleveland, OH 44195 USA
[6] Hsin Jen Hosp, Dialysis Ctr, Dept Internal Med, Hsin Ren Clin,Div Nephrol, 395 Chung Shan Rd, New Taipei 231, Taiwan
[7] Vrije Univ Brussel, Univ Ziekenhuis Brussel, ICU Dept, 101 Laarbeeklaan, B-1090 Jette, Belgium
[8] CHU Brugmann, Univ Hosp, ICU Dept, 4 Pl Arthur Gehucthen, B-1020 Brussels, Belgium
[9] Natl Taiwan Univ Hosp, Study Grp ARF, NSARF Grp, Taipei 100, Taiwan
关键词
acute kidney injury; biomarker; fibroblast growth factor-23; kidney injury molecule-1; mortality; neutrophil gelatinase-associated lipocalin; renal replacement therapy; RENAL REPLACEMENT THERAPY; GROWTH-FACTOR; 23; PRIMARY ALDOSTERONISM; RISK; FGF23; AKI; EXPRESSION; FACTOR-23; MORTALITY; RICKETS;
D O I
10.3390/jcm7080202
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
The ideal circumstances for whether and when to start RRT remain unclear. The outcome predictive ability of acute kidney injury (AKI) biomarkers measuring at dialysis initializing need more validation. This prospective, multi-center observational cohort study enrolled 257 patients with AKI undergoing renal replacement therapy (RRT) shortly after admission. At the start of RRT, blood and urine samples were collected for relevant biomarker measurement. RRT dependence and all-cause mortality were recorded up to 90 days after discharge. Areas under the receiver operator characteristic (AUROC) curves and a multivariate generalized additive model were applied to predict outcomes. One hundred and thirty-five (52.5%) patients died within 90 days of hospital discharge. Plasma c-terminal FGF-23 (cFGF-23) had the best discriminative ability (AUROC, 0.687) as compared with intact FGF-23 (iFGF-23) (AUROC, 0.504), creatinine-adjusted urine neutrophil gelatinase-associated lipocalin (AUROC, 0.599), and adjusted urine cFGF-23 (AUROC, 0.653) regardless whether patients were alive or not on day 90. Plasma cFGF-23 levels above 2050 RU/mL were independently associated with higher 90-day mortality (HR 1.76, p = 0.020). Higher cFGF-23 levels predicted less weaning from dialysis in survivors (HR, 0.62, p = 0.032), taking mortality as a competing risk. Adding cFGF-23 measurement to the AKI risk predicting score significantly improved risk stratification and 90-day mortality prediction (total net reclassification improvement = 0.148; p = 0.002). In patients with AKI who required RRT, increased plasma cFGF-23 levels correlated with higher 90-day overall mortality after discharge and predicted worse kidney recovery in survivors. When coupled to the AKI risk predicting score, cFGF-23 significantly improved mortality risk prediction. This observation adds evidence that cFGF-23 could be used as an optimal timing biomarker to initiate RRT.
引用
收藏
页数:17
相关论文
共 39 条
[1]   Preoperative plasma FGF23 levels predict acute kidney injury in children: results of a pilot study [J].
Ali, Farah N. ;
Hassinger, Amanda ;
Price, Heather ;
Langman, Craig B. .
PEDIATRIC NEPHROLOGY, 2013, 28 (06) :959-962
[2]   Phosphatonins and the regulation of phosphate homeostasis [J].
Berndt, Theresa ;
Kumar, Rajiv .
ANNUAL REVIEW OF PHYSIOLOGY, 2007, 69 :341-359
[3]   Fibroblast Growth Factor-23 and the Long-Term Risk of Hospital-Associated AKI among Community-Dwelling Older Individuals [J].
Brown, Jeremiah R. ;
Katz, Ronit ;
Ix, Joachim H. ;
de Boer, Ian H. ;
Siscovick, David S. ;
Grams, Morgan E. ;
Shlipak, Michael ;
Sarnak, Mark J. .
CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, 2014, 9 (02) :239-246
[4]   Acute Kidney Injury Enhances Outcome Prediction Ability of Sequential Organ Failure Assessment Score in Critically Ill Patients [J].
Chang, Chih-Hsiang ;
Fan, Pei-Chun ;
Chang, Ming-Yang ;
Tian, Ya-Chung ;
Hung, Cheng-Chieh ;
Fang, Ji-Tseng ;
Yang, Chih-Wei ;
Chen, Yung-Chang .
PLOS ONE, 2014, 9 (10)
[5]   Plasma FGF23 levels increase rapidly after acute kidney injury [J].
Christov, Marta ;
Waikar, Sushrut S. ;
Pereira, Renata C. ;
Havasi, Andrea ;
Leaf, David E. ;
Goltzman, David ;
Pajevic, Paola D. ;
Wolf, Myles ;
Jueppner, Harald .
KIDNEY INTERNATIONAL, 2013, 84 (04) :776-785
[6]   Model to Predict Mortality in Critically Ill Adults with Acute Kidney Injury [J].
Demirjian, Sevag ;
Chertow, Glenn M. ;
Zhang, Jane Hongyuan ;
O'Connor, Theresa Z. ;
Vitale, Joseph ;
Paganini, Emil P. ;
Palevsky, Paul M. .
CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, 2011, 6 (09) :2114-2120
[7]   Pathophysiological Implications of Fibroblast Growth Factor-23 and Klotho and Their Potential Role as Clinical Biomarkers [J].
Donate-Correa, Javier ;
Muros de Fuentes, Mercedes ;
Mora-Fernandez, Carmen ;
Navarro-Gonzalez, Juan F. .
CLINICAL CHEMISTRY, 2014, 60 (07) :933-940
[8]   FGF23 induces left ventricular hypertrophy [J].
Faul, Christian ;
Amaral, Ansel P. ;
Oskouei, Behzad ;
Hu, Ming-Chang ;
Sloan, Alexis ;
Isakova, Tamara ;
Gutierrez, Orlando M. ;
Aguillon-Prada, Robier ;
Lincoln, Joy ;
Hare, Joshua M. ;
Mundel, Peter ;
Morales, Azorides ;
Scialla, Julia ;
Fischer, Michael ;
Soliman, Elsayed Z. ;
Chen, Jing ;
Go, Alan S. ;
Rosas, Sylvia E. ;
Nessel, Lisa ;
Townsend, Raymond R. ;
Feldman, Harold I. ;
Sutton, Martin St. John ;
Ojo, Akinlolu ;
Gadegbeku, Crystal ;
Di Marco, Giovana Seno ;
Reuter, Stefan ;
Kentrup, Dominik ;
Tiemann, Klaus ;
Brand, Marcus ;
Hill, Joseph A. ;
Moe, Orson W. ;
Kuro-o, Makoto ;
Kusek, John W. ;
Keane, Martin G. ;
Wolf, Myles .
JOURNAL OF CLINICAL INVESTIGATION, 2011, 121 (11) :4393-4408
[9]   The fibroblast growth factor receptor mediates the increased FGF23 expression in acute and chronic uremia [J].
Hassan, Alia ;
Durlacher, Karina ;
Silver, Justin ;
Naveh-Many, Tally ;
Levi, Ronen .
AMERICAN JOURNAL OF PHYSIOLOGY-RENAL PHYSIOLOGY, 2016, 310 (03) :F217-F221
[10]  
Hin LY, 1999, STAT MED, V18, P1101, DOI 10.1002/(SICI)1097-0258(19990515)18:9<1101::AID-SIM99>3.3.CO