Journal
CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY
Volume 8, Issue 7, Pages 1079-1088Publisher
AMER SOC NEPHROLOGY
DOI: 10.2215/CJN.10971012
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Funding
- National Heart, Lung, and Blood Institute [R01HL-085757]
- Clinical and Translational Science Award from the National Center for Research Resources [UL1 RR024139]
- Career Development Award from the National Institutes of Health (NIH) [K23DK080132]
- NIH [K24DK090203]
- NIH-sponsored Assess, Serial Evaluation, and Subsequent Sequelae in Acute Kidney Injury (ASSESS-AKI) Consortium [U01DK082185]
- Abbott Diagnostics and Sekisui Diagnostics, Inc.
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Background and objectives AKI is common and novel biomarkers may help provide earlier diagnosis and prognosis of AKI in the postoperative period. Design, setting, participants, & measurements This was a prospective, multicenter cohort study involving 1219 adults and 311 children consecutively enrolled at eight academic medical centers. Performance of two urine biomarkers, kidney injury molecule-1 (KIM-1) and liver fatty acid-binding protein (L-FABP), alone or in combination with other injury biomarkers during the perioperative period was evaluated. AM was defined as doubling of serum creatinine or need for acute dialysis. Results KIM-1 peaked 2 days after surgery in adults and 1 day after surgery in children, whereas L-FABP peaked within 6 hours after surgery in both age groups. In multivariable analyses, the highest quintile of the first postoperative KIM-1 level was associated with AKI compared with the lowest quintile in adults, whereas the first postoperative L-FABP was not associated with AM. Both KIM-1 and L-FABP were not significantly associated with AKI in adults or children after adjusting for other kidney injury biomarkers (neutrophil gelatinase-associated lipocalin and IL-18). The highest area under the curves achievable for discrimination for AKI were 0.78 in adults using urine KIM-1 from 6 to 12 hours, urine IL-18 from day 2, and plasma neutrophil gelatinaseassociated lipocalin from day 2 and 0.78 in children using urine IL-18 from 0 to 6 hours and urine L-FABP from day 2. Conclusions Postoperative elevations of KIM-1 associate with AKI and adverse outcmes in adults but were not independent of other AKI biomarkers. A panel of multiple biomarkers provided moderate discrimination for AM.
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