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1. Recommendations for clinical trial design in acute kidney injury from the 31st acute disease quality initiative consensus conference. A consensus statement

Author

Zarbock, Alexander, Forni, Lui G., Koyner, Jay L., Bell, Samira, Reis, Thiago, Meersch, Melanie, Bagshaw, Sean M., Fuhmann, Dana Y., Liu, Kathleen D., Pannu, Neesh, Arikan, Ayse Akcan, Angus, Derek C., Duquette, D‘Arcy, Goldstein, Stuart L., Hoste, Eric, Joannidis, Michael, Jongs, Niels, Legrand, Matthieu, Mehta, Ravindra L., Murray, Patrick T., Nadim, Mitra K., Ostermann, Marlies, Prowle, John, See, Emily J., Selby, Nicholas M., Shaw, Andrew D., Srisawat, Nattachai, Ronco, Claudio, and Kellum, John A.

Published
2024
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2. Digital health and acute kidney injury: consensus report of the 27th Acute Disease Quality Initiative workgroup

Author

Kashani, Kianoush B., Awdishu, Linda, Bagshaw, Sean M., Barreto, Erin F., Claure-Del Granado, Rolando, Evans, Barbara J., Forni, Lui G., Ghosh, Erina, Goldstein, Stuart L., Kane-Gill, Sandra L., Koola, Jejo, Koyner, Jay L., Liu, Mei, Murugan, Raghavan, Nadkarni, Girish N., Neyra, Javier A., Ninan, Jacob, Ostermann, Marlies, Pannu, Neesh, Rashidi, Parisa, Ronco, Claudio, Rosner, Mitchell H., Selby, Nicholas M., Shickel, Benjamin, Singh, Karandeep, Soranno, Danielle E., Sutherland, Scott M., Bihorac, Azra, and Mehta, Ravindra L.

Published
2023
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3. Efficacy and safety of therapeutic alpha-1-microglobulin RMC-035 in reducing kidney injury after cardiac surgery: a multicentre, randomised, double-blind, parallel group, phase 2a trial

Author

Nazar, Belén Adrio, Böhm, Johannes, Böning, Andreas, Brown, Craig, Burkert, Jan, de Varennes, Benoit, East, Cara, Engelman, Dan, Iglesias, Antonino Ginel, Helms, Sven, Koyner, Jay L., Kress, David, Laflamme, Maxime, Lamy, Andre, Larsson, Tobias E., Matschke, Klaus, Mazer, C David, Albaiceta, Guillermo Muniz, Carvajal, Ignacio Munoz, Myjavec, Andrej, Noiseux, Nicolas, Osaki, Saturo, Reusch, Michael, Copa, Guillermo Reyes, Ronco, Claudio, Scavo, Vincent, Shelstad, Ryan, Swaminathan, Madhav, Szabo, Gabor, Teman, Nicholas, Thielmann, Matthias, Vojacek, Jan, Wahlers, Thorsten, Zarbock, Alexander, and Mazer, C. David

Published
2024
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7. Sepsis-associated acute kidney injury: consensus report of the 28th Acute Disease Quality Initiative workgroup

Author

Zarbock, Alexander, Nadim, Mitra K., Pickkers, Peter, Gomez, Hernando, Bell, Samira, Joannidis, Michael, Kashani, Kianoush, Koyner, Jay L., Pannu, Neesh, Meersch, Melanie, Reis, Thiago, Rimmelé, Thomas, Bagshaw, Sean M., Bellomo, Rinaldo, Cantaluppi, Vicenzo, Deep, Akash, De Rosa, Silvia, Perez-Fernandez, Xose, Husain-Syed, Faeq, Kane-Gill, Sandra L., Kelly, Yvelynne, Mehta, Ravindra L., Murray, Patrick T., Ostermann, Marlies, Prowle, John, Ricci, Zaccaria, See, Emily J., Schneider, Antoine, Soranno, Danielle E., Tolwani, Ashita, Villa, Gianluca, Ronco, Claudio, and Forni, Lui G.

Published
2023
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8. Pathophysiology of COVID-19-associated acute kidney injury

Author

Legrand, Matthieu, Bell, Samira, Forni, Lui, Joannidis, Michael, Koyner, Jay L, Liu, Kathleen, and Cantaluppi, Vincenzo

Subjects
Infectious Diseases, Hematology, Sepsis, Kidney Disease, 2.1 Biological and endogenous factors, Aetiology, Renal and urogenital, Good Health and Well Being, Acute Kidney Injury, Adaptive Immunity, Biopsy, COVID-19, Complement System Proteins, Drug-Related Side Effects and Adverse Reactions, Endothelium, Vascular, Extracorporeal Membrane Oxygenation, Hematuria, Humans, Immunity, Humoral, Immunity, Innate, Immunosenescence, Inflammation, Interferon Type I, Kidney, Proteinuria, Severity of Illness Index, Viral Load, Clinical Sciences, Urology & Nephrology
Abstract

Although respiratory failure and hypoxaemia are the main manifestations of COVID-19, kidney involvement is also common. Available evidence supports a number of potential pathophysiological pathways through which acute kidney injury (AKI) can develop in the context of SARS-CoV-2 infection. Histopathological findings have highlighted both similarities and differences between AKI in patients with COVID-19 and in those with AKI in non-COVID-related sepsis. Acute tubular injury is common, although it is often mild, despite markedly reduced kidney function. Systemic haemodynamic instability very likely contributes to tubular injury. Despite descriptions of COVID-19 as a cytokine storm syndrome, levels of circulating cytokines are often lower in patients with COVID-19 than in patients with acute respiratory distress syndrome with causes other than COVID-19. Tissue inflammation and local immune cell infiltration have been repeatedly observed and might have a critical role in kidney injury, as might endothelial injury and microvascular thrombi. Findings of high viral load in patients who have died with AKI suggest a contribution of viral invasion in the kidneys, although the issue of renal tropism remains controversial. An impaired type I interferon response has also been reported in patients with severe COVID-19. In light of these observations, the potential pathophysiological mechanisms of COVID-19-associated AKI may provide insights into therapeutic strategies.

Published
2021

9. Postoperative acute kidney injury in adult non-cardiac surgery: joint consensus report of the Acute Disease Quality Initiative and PeriOperative Quality Initiative

Author

Prowle, John R, Forni, Lui G, Bell, Max, Chew, Michelle S, Edwards, Mark, Grams, Morgan E, Grocott, Michael PW, Liu, Kathleen D, McIlroy, David, Murray, Patrick T, Ostermann, Marlies, Zarbock, Alexander, Bagshaw, Sean M, Bartz, Raquel, Bell, Samira, Bihorac, Azra, Gan, Tong J, Hobson, Charles E, Joannidis, Michael, Koyner, Jay L, Levett, Denny ZH, Mehta, Ravindra L, Miller, Timothy E, Mythen, Michael G, Nadim, Mitra K, Pearse, Rupert M, Rimmele, Thomas, Ronco, Claudio, Shaw, Andrew D, and Kellum, John A

Subjects
Prevention, Cardiovascular, Patient Safety, Clinical Research, Kidney Disease, Renal and urogenital, Good Health and Well Being, Acute Kidney Injury, Humans, Kidney, Postoperative Complications, Risk Factors, Clinical Sciences, Urology & Nephrology
Abstract

Postoperative acute kidney injury (PO-AKI) is a common complication of major surgery that is strongly associated with short-term surgical complications and long-term adverse outcomes, including increased risk of chronic kidney disease, cardiovascular events and death. Risk factors for PO-AKI include older age and comorbid diseases such as chronic kidney disease and diabetes mellitus. PO-AKI is best defined as AKI occurring within 7 days of an operative intervention using the Kidney Disease Improving Global Outcomes (KDIGO) definition of AKI; however, additional prognostic information may be gained from detailed clinical assessment and other diagnostic investigations in the form of a focused kidney health assessment (KHA). Prevention of PO-AKI is largely based on identification of high baseline risk, monitoring and reduction of nephrotoxic insults, whereas treatment involves the application of a bundle of interventions to avoid secondary kidney injury and mitigate the severity of AKI. As PO-AKI is strongly associated with long-term adverse outcomes, some form of follow-up KHA is essential; however, the form and location of this will be dictated by the nature and severity of the AKI. In this Consensus Statement, we provide graded recommendations for AKI after non-cardiac surgery and highlight priorities for future research.

Published
2021

11. Publisher Correction: COVID-19-associated acute kidney injury: consensus report of the 25th Acute Disease Quality Initiative (ADQI) Workgroup

Author

Nadim, Mitra K, Forni, Lui G, Mehta, Ravindra L, Connor, Michael J, Liu, Kathleen D, Ostermann, Marlies, Rimmelé, Thomas, Zarbock, Alexander, Bell, Samira, Bihorac, Azra, Cantaluppi, Vincenzo, Hoste, Eric, Husain-Syed, Faeq, Germain, Michael J, Goldstein, Stuart L, Gupta, Shruti, Joannidis, Michael, Kashani, Kianoush, Koyner, Jay L, Legrand, Matthieu, Lumlertgul, Nuttha, Mohan, Sumit, Pannu, Neesh, Peng, Zhiyong, Perez-Fernandez, Xose L, Pickkers, Peter, Prowle, John, Reis, Thiago, Srisawat, Nattachai, Tolwani, Ashita, Vijayan, Anitha, Villa, Gianluca, Yang, Li, Ronco, Claudio, and Kellum, John A

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Renal and urogenital, Good Health and Well Being, Urology & Nephrology, Clinical sciences
Abstract

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Published
2020

12. COVID-19-associated acute kidney injury: consensus report of the 25th Acute Disease Quality Initiative (ADQI) Workgroup

Author

Nadim, Mitra K, Forni, Lui G, Mehta, Ravindra L, Connor, Michael J, Liu, Kathleen D, Ostermann, Marlies, Rimmelé, Thomas, Zarbock, Alexander, Bell, Samira, Bihorac, Azra, Cantaluppi, Vincenzo, Hoste, Eric, Husain-Syed, Faeq, Germain, Michael J, Goldstein, Stuart L, Gupta, Shruti, Joannidis, Michael, Kashani, Kianoush, Koyner, Jay L, Legrand, Matthieu, Lumlertgul, Nuttha, Mohan, Sumit, Pannu, Neesh, Peng, Zhiyong, Perez-Fernandez, Xose L, Pickkers, Peter, Prowle, John, Reis, Thiago, Srisawat, Nattachai, Tolwani, Ashita, Vijayan, Anitha, Villa, Gianluca, Yang, Li, Ronco, Claudio, and Kellum, John A

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Prevention, Kidney Disease, Renal and urogenital, Good Health and Well Being, Acute Kidney Injury, Anticoagulants, COVID-19, Consensus, Humans, Renal Replacement Therapy, Risk Factors, SARS-CoV-2, Urology & Nephrology, Clinical sciences
Abstract

Kidney involvement in patients with coronavirus disease 2019 (COVID-19) is common, and can range from the presence of proteinuria and haematuria to acute kidney injury (AKI) requiring renal replacement therapy (RRT; also known as kidney replacement therapy). COVID-19-associated AKI (COVID-19 AKI) is associated with high mortality and serves as an independent risk factor for all-cause in-hospital death in patients with COVID-19. The pathophysiology and mechanisms of AKI in patients with COVID-19 have not been fully elucidated and seem to be multifactorial, in keeping with the pathophysiology of AKI in other patients who are critically ill. Little is known about the prevention and management of COVID-19 AKI. The emergence of regional 'surges' in COVID-19 cases can limit hospital resources, including dialysis availability and supplies; thus, careful daily assessment of available resources is needed. In this Consensus Statement, the Acute Disease Quality Initiative provides recommendations for the diagnosis, prevention and management of COVID-19 AKI based on current literature. We also make recommendations for areas of future research, which are aimed at improving understanding of the underlying processes and improving outcomes for patients with COVID-19 AKI.

Published
2020

14. Quality of Care for Acute Kidney Disease: Current Knowledge Gaps and Future Directions

Author

Liu, Kathleen D, Forni, Lui G, Heung, Michael, Wu, Vin-Cent, Kellum, John A, Mehta, Ravindra L, Ronco, Claudio, Kashani, Kianoush, Rosner, Mitchell H, Haase, Michael, Koyner, Jay L, Investigators, Acute Disease Quality Initiative, and Mehta, Ravi

Subjects
Health Services and Systems, Biomedical and Clinical Sciences, Clinical Sciences, Health Sciences, Kidney Disease, Clinical Research, Patient Safety, Renal and urogenital, Good Health and Well Being, acute kidney injury, outcomes, quality, recovery, Acute Disease Quality Initiative Investigators, Biomedical and clinical sciences, Health sciences
Abstract

Acute kidney injury (AKI) and acute kidney disease (AKD) are common complications in hospitalized patients and are associated with adverse outcomes. Although consensus guidelines have improved the care of patients with AKI and AKD, guidance regarding quality metrics in the care of patients after an episode of AKI or AKD is limited. For example, few patients receive follow-up laboratory testing of kidney function or post-AKI or AKD care through nephrology or other providers. Recently, the Acute Disease Quality Initiative developed a consensus statement regarding quality improvement goals for patients with AKI or AKD specifically highlighting efforts regarding quality and safety of care after hospital discharge after an episode of AKI or AKD. The goal is to use these measures to identify opportunities for improvement that will positively affect outcomes. We recommend that health care systems quantitate the proportion of patients who need and actually receive follow-up care after the index AKI or AKD hospitalization. The intensity and appropriateness of follow-up care should depend on patient characteristics, severity, duration, and course of AKI of AKD, and should evolve as evidence-based guidelines emerge. Quality indicators for discharged patients with dialysis requiring AKI or AKD should be distinct from end-stage renal disease measures. Besides, there should be specific quality indicators for those still requiring dialysis in the outpatient setting after AKI or AKD. Given the limited preexisting data guiding the care of patients after an episode of AKI or AKD, there is ample opportunity to establish quality measures and potentially improve patient care and outcomes. This review will provide specific evidence-based and expert opinion-based guidance for the care of patients with AKI or AKD after hospital discharge.

Published
2020

15. Controversies in acute kidney injury: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Conference

Author

Ostermann, Marlies, Bellomo, Rinaldo, Burdmann, Emmanuel A, Doi, Kent, Endre, Zoltan H, Goldstein, Stuart L, Kane-Gill, Sandra L, Liu, Kathleen D, Prowle, John R, Shaw, Andrew D, Srisawat, Nattachai, Cheung, Michael, Jadoul, Michel, Winkelmayer, Wolfgang C, Kellum, John A, Participants, Conference, Bagshaw, Sean M, Barreto, Erin F, Bihorac, Azra, Bobek, Ilona, Bouchard, Josée, Cerdá, Jorge, Chakravarthi, Rajasekara, De Rosa, Silvia, Engelman, Daniel T, Forni, Lui G, Hemmilä, Ulla K, Herzog, Charles A, Hoste, Eric A, Huen, Sarah C, Iseki, Kunitoshi, Joannidis, Michael, Kashani, Kianoush B, Koyner, Jay L, Kribben, Andreas, Lameire, Norbert, Levey, Andrew S, Macedo, Etienne, Małyszko, Jolanta, Meersch, Melanie, Mehta, Ravindra L, Mewburn, Irene, Mironova, Olga, Murray, Patrick T, Nadim, Mitra K, Pan, Jenny S, Pannu, Neesh, Peng, Zhiyong, Philips, Barbara, Ponce, Daniela, Ray, Patricio E, Ricci, Zaccaria, Rimmelé, Thomas, Ronco, Claudio, Siew, Edward D, Stevens, Paul E, Tolwani, Ashita J, Tonelli, Marcello, Vaara, Suvi T, van Dam, Marjel, Vijayan, Anitha, Wise, Michael, Wu, Vin-Cent, and Zarbock, Alexander

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Kidney Disease, 7.3 Management and decision making, Management of diseases and conditions, Renal and urogenital, Acute Kidney Injury, Humans, acute kidney disease, acute kidney injury, fluid management, nephrotoxicity, renal replacement therapy, risk stratification, Conference Participants, Urology & Nephrology, Clinical sciences
Abstract

In 2012, Kidney Disease: Improving Global Outcomes (KDIGO) published a guideline on the classification and management of acute kidney injury (AKI). The guideline was derived from evidence available through February 2011. Since then, new evidence has emerged that has important implications for clinical practice in diagnosing and managing AKI. In April of 2019, KDIGO held a controversies conference entitled Acute Kidney Injury with the following goals: determine best practices and areas of uncertainty in treating AKI; review key relevant literature published since the 2012 KDIGO AKI guideline; address ongoing controversial issues; identify new topics or issues to be revisited for the next iteration of the KDIGO AKI guideline; and outline research needed to improve AKI management. Here, we present the findings of this conference and describe key areas that future guidelines may address.

Published
2020

16. Serial Urinary C-C Motif Chemokine Ligand 14 and Risk of Persistent Severe Acute Kidney Injury

Author

Prowle, John R., Artigas, Antonio, Bagshaw, Sean M., Forni, Lui G., Heung, Michael, Hoste, Eric, Marlies, Ostermann, Koyner, Jay L., Chawla, Lakmir, Kampf, J. Patrick, Kwan, Thomas, McPherson, Paul, Kellum, John A., Kashani, K, Al-Khafaji, A, Ardiles, T, Artigas, A, Bagshaw, SM, Bell, M, Bihorac, A, Birkhahn, R, Cely, CM, Chawla, LS, Davison, D, Feldkamp, T, Forni, LG, Gong, MN, Gunnerson, KJ, Haase, M, Hackett, J, Honore, P, Hoste, EAJ, Joannes-Boyau, O, Joannidis, M, Kim, P, Koyner, JL, Laskowitz, DT, Lissauer, ME, Marx, G, McCullough, PA, Mullaney, S, Ostermann, M, Rimmele, T, Shapiro, NI, Shaw, AD, Shi, J, Walker, MG, Sprague, AM, Vincent, JL, Vinsonneau, C, Wagner, L, Wilkerson, RG, Zacharowski, K, Kellum, JA, Hoste, Eric, Bihora, Azra, Al-Khafaji, Ali, Ortega, Luis M., Ostermann, Marlies, Haase, Michael, Zacharowski, Kai, Wunderink, Richard, Heung, Michael, Gunnerson, Kyle, Lissauer, Matthew, Herr, Daniel, Self, Wesley H., Koyner, Jay L., Honore, Patrick M., Prowle, John R., Davison, Danielle, Artigas, Antonio, Joannidis, Michael, Schroeder, Rebecca, Demirjian, Sevag, Forni, Lui G., Hodgson, Luke, Wilber, Scott T., Frey, Jennifer A., Reilly, Ian, Shi, Jing, Patrick Kampf, J., Kwan, Thomas, McPherson, Paul, Kellum, John A., and Chawla, Lakhmir S.

Published
2023
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17. The Association of Angiogenesis Markers With Acute Kidney Injury and Mortality After Cardiac Surgery

Author

Mansour, Sherry G, Zhang, William R, Moledina, Dennis G, Coca, Steven G, Jia, Yaqi, Thiessen-Philbrook, Heather, McArthur, Eric, Inoue, Kazunori, Koyner, Jay L, Shlipak, Michael G, Wilson, F Perry, Garg, Amit X, Ishibe, Shuta, Parikh, Chirag R, and Consortium, TRIBE-AKI

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Cardiovascular, Clinical Research, Kidney Disease, Renal and urogenital, Good Health and Well Being, Acute Kidney Injury, Aged, Biomarkers, Cardiac Surgical Procedures, Creatinine, Endpoint Determination, Female, Humans, Kidney, Male, Middle Aged, Neovascularization, Physiologic, Outcome Assessment, Health Care, Postoperative Complications, Prospective Studies, Receptors, Vascular Endothelial Growth Factor, Risk Assessment, United States, Vascular Endothelial Growth Factor A, TRIBE-AKI Consortium, AKI duration, Acute kidney injury, VEGF-A, angiogenesis, angiogenic growth factor, biomarker, cardiac surgery, cytokine, mortality, placental growth factor, soluble VEGF receptor 1, vascular endothelial growth factor A, Public Health and Health Services, Urology & Nephrology, Clinical sciences
Abstract

Rationale & objectiveThe process of angiogenesis after kidney injury may determine recovery and long-term outcomes. We evaluated the association of angiogenesis markers with acute kidney injury (AKI) and mortality after cardiac surgery.Study designProspective cohort.Setting & participants1,444 adults undergoing cardiac surgery in the TRIBE-AKI (Translational Research Investigating Biomarker Endpoints for Acute Kidney Injury) cohort.ExposuresPlasma concentrations of 2 proangiogenic markers (vascular endothelial growth factor A [VEGF] and placental growth factor [PGF]) and 1 antiangiogenic marker (soluble VEGF receptor 1 [VEGFR1]), measured pre- and postoperatively within 6 hours after surgery.OutcomesAKI, long AKI duration (≥7 days), and 1-year all-cause mortality.Analytical approachMultivariable logistic regression.ResultsFollowing cardiac surgery, plasma VEGF concentrations decreased 2-fold, and PGF and VEGFR1 concentrations increased 1.5- and 8-fold, respectively. There were no meaningful associations of preoperative concentrations of angiogenic markers with outcomes of AKI and mortality. Higher postoperative VEGF and PGF concentrations were independently associated with lower odds of AKI (adjusted ORs of 0.89 [95% CI, 0.82-0.98] and 0.69 [95% CI, 0.55-0.87], respectively), long AKI duration (0.65 [95% CI, 0.49-0.87] and 0.48 [95% CI, 0.28-0.82], respectively), and mortality (0.74 [95% CI, 0.62-0.89] and 0.46 [95% CI, 0.31-0.68], respectively). In contrast, higher postoperative VEGFR1 concentrations were independently associated with higher odds of AKI (1.56; 95% CI, 1.31-1.87), long AKI duration (1.75; 95% CI, 1.09-2.82), and mortality (2.28; 95% CI, 1.61-3.22).LimitationsAngiogenesis markers were not measured after hospital discharge, so we were unable to determine long-term trajectories of angiogenesis marker levels during recovery and follow-up.ConclusionsHigher levels of postoperative proangiogenic markers, VEGF and PGF, were associated with lower AKI and mortality risk, whereas higher postoperative antiangiogenic VEGFR1 levels were associated with higher risk for AKI and mortality.

Published
2019

23. Kidney Recovery and Death in Critically Ill Patients With COVID-19–Associated Acute Kidney Injury Treated With Dialysis: The STOP-COVID Cohort Study

Author

Gupta, Hsu, Faugno, Goyal, Raichoudhury, Tariq, Meyer, Sharma, Leaf, Kshirsagar, Walther, Carl P., Anumudu, Samaya J., Arunthamakun, Justin, Kopecky, Kathleen F., Milligan, Gregory P., McCullough, Peter A., Nguyen, Thuy-Duyen, Shaefi, Shahzad, Krajewski, Megan L., Shankar, Sidharth, Pannu, Ameeka, Valencia, Juan D., Bauer, Kenneth A., Waikar, Sushrut S., Kibbelaar, Zoe A., Athavale, Ambarish M., Hart, Peter, Upadhyay, Shristi, Vohra, Ishaan, Oyintayo, Ajiboye, Green, Adam, Rachoin, Jean-Sebastien, Schorr, Christa A., Shea, Lisa, Edmonston, Daniel L., Mosher, Christopher L., Shehata, Alexandre M., Cohen, Zaza, Allusson, Valerie, Bambrick-Santoyo, Gabriela, Bhatti, Noor ul aain, Mehta, Bijal, WilliamsSamantha K. Brenner, Aquino, Walters, Patricia, Go, Ronaldo C., Rose, Keith M., Hernán, Miguel A., Zhou, Amy M., Kim, Ethan C., Lisk, Rebecca, Chan, Lili, Mathews, Kusum S., Coca, Steven G., Altman, Deena R., Saha, Aparna, Soh, Howard, Wen, Huei Hsun, Bose, Sonali, Leven, Emily A., Wang, Jing G., Mosoyan, Gohar, Pattharanitima, Pattharawin, Gallagher, Emily J., Friedman, Allon N., Guirguis, John, Kapoor, Rajat, Meshberger, Christopher, Kelly, Katherine J., Parikh, Chirag R., Garibaldi, Brian T., Corona-Villalobos, Celia P., Wen, Yumeng, Menez, Steven, Malik, Rubab F., Cervantes, Carmen Elena, Gautam, Samir C., Mallappallil, Mary C., Ouyang, Jie, John, Sabu, Yap, Ernie, Melaku, Yohannes, Mohamed, Ibrahim, Bajracharya, Siddhartha, Puri, Isha, Thaxton, Mariah, Bhattacharya, Jyotsna, Wagner, John, Boudourakis, Leon, Nguyen, H. Bryant, Ahoubim, Afshin, Thomas, Leslie F., Sirganagari, Dheeraj Reddy, Guru, Pramod K., Kashani, Kianoush, Tehranian, Shahrzad, Zhou, Yan, Bergl, Paul A., Rodriguez, Jesus, Shah, Jatan A., Gupta, Mrigank S., Kumar, Princy N., Lazarous, Deepa G., Kassaye, Seble G., Melamed, Michal L., Johns. Ryan Mocerino, Tanya S., Prudhvi, Kalyan, Zhu, Denzel, Levy, Rebecca V., Azzi, Yorg, Fisher, Molly, Yunes, Milagros, Sedaliu, Kaltrina, Golestaneh, Ladan, Brogan, Maureen, Thakkar, Jyotsana, Kumar, Neelja, Ross, Michael J., Chang, Michael, Athreya, Akshay, Farag, Mohamed, Schenck, Edward J., Cho, Soo Jung, Plataki, Maria, Alvarez-Mulett, Sergio L., Gomez-Escobar, Luis G., Pan, Di, Lee, Stefi, Krishnan, Jamuna, Whalen, William, Charytan, David, Macina, Ashley, Srivastava, Anand, Leidner, Alexander S., Martinez, Carlos, Kruser, Jacqueline M., Wunderink, Richard G., Hodakowski, Alexander J., Velez, Juan Carlos Q., Price-Haywood, Eboni G., Matute-Trochez, Luis A., Hasty, Anna E., Mohamed, Muner M.B., Avasare, Rupali S., Zonies, David, Al-Samkari, Hanny, Leaf, Rebecca Karp, Rosovsky, Rachel, Sise, Meghan E., Newman, Erik T., Omar, Samah Abu, Pokharel, Kapil K., Sharma, Shreyak, Singh, Harkarandeep, Correa, Simon, Shaukat, Tanveer, Kamal, Omer, Wang, Wei, Lee, Meghan, Strohbehn, Ian A., Li, Jiahua, Mueller, Ariel L., Redfern, Roberta E., Cairl, Nicholas S., Naimy, Gabriel, Abu-Saif, Abeer, Hall, Danyell, Bickley, Laura, Rowan, Chris, Madhani-Lovely, Farah, Peev, Vasil, Reiser, Jochen, Byun, John J., Vissing, Andrew, Kapania, Esha M., Post, Zoe, Patel, Nilam P., Hermes, Joy-Marie, Sutherland, Anne K., Patrawalla, Amee, Finkel, Diana G., Danek, Barbara A., Arikapudi, Sowminya, Paer, Jeffrey M., Cangialosi, Peter, Liotta, Mark, Radbel, Jared, Puri, Sonika, Sunderram, Jag, Scharf, Matthew T., Ahmed, Ayesha, Berim, Ilya, Vatson, Jayanth S., Karp, George, Anand, Shuchi, Levitt, Joseph E., Garcia, Pablo, Boyle, Suzanne M., Song, Rui, Zhang, Jingjing, Woo, Sang Hoon, Deng, Xiaoying, Katz-Greenberg, Goni, Sharshir, Moh’d A., Rusnak, Vadym V., Bansal, Anip, Podoll, Amber S., Chonchol, Michel, Sharma, Sunita, Burnham, Ellen L., Rashidi, Arash, Hejal, Rana, Judd, Eric, Latta, Laura, Tolwani, Ashita, Albertson, Timothy E., Adams, Jason Y., Chang, Steven Y., Beutler, Rebecca M., Schulze, Carl E., Macedo, Etienne, RheeKa, Harin, thleen D. Liu, Jotwani, Vasantha K., Koyner, Jay L., Shah, Chintan V., Jaikaransingh, Vishal, Toth-Manikowski, Stephanie M., Joo, Min J., Lash, James P., Neyra, Javier A., Chaaban, Nourhan, Elias, Madona, Ahmad, Yahya, Dy, Rajany, Iardino, Alfredo, Au, Elizabeth H., Sosa, Marie Anne, Taldone, Sabrina, Contreras, Gabriel, De La Zerda, David, Gershengorn, Hayley B., Fornoni, Alessia, Hayek, Salim S., Blakely, Pennelope, Berlin, Hanna, Azam, Tariq U., Shadid, Husam, Pan, Michael, O’Hayer, Patrick, Meloche, Chelsea, Feroze, Rafey, Padalia, Kishan J., Leya, Jeff, Donnelly, John P., Admon, Andrew J., Flythe, Jennifer E., Tugman, Matthew J., Chang, Emily H., Brown, Brent R., Leonberg-Yoo, Amanda K., Spiardi, Ryan C., Miano, Todd A., Roche, Meaghan S., Vasquez, Charles R., Bansal, Amar D., Ernecoff, Natalie C., Kapoor, Sanjana, Verma, Siddharth, Chen, Huiwen, Kovesdy, Csaba P., Molnar, Miklos Z., Azhar, Ambreen, Hedayati, S. Susan, Nadamuni, Mridula V., Shastri, Shani, Willett, Duwayne L., Short, Samuel A.P., Renaghan, Amanda D., Enfield, Kyle B., Bhatraju, Pavan K., Malik, A. Bilal, Semler, Matthew W., Vijayan, Anitha, Joy, Christina Mariyam, Li, Tingting, Goldberg, Seth, Kao, Patricia F., Schumaker, Greg L., Christov, Marta, Griffiths, Jennifer, Gupta, Sanjeev, Kapoor, Aromma, Chugh, Savneek, Wilson, Perry, Arora, Tanima, Ugwuowo, Ugochukwu, Hsu, Caroline M., Gupta, Shruti, Tighiouart, Hocine, Goyal, Nitender, Faugno, Anthony J., Tariq, Asma, Raichoudhury, Ritesh, Sharma, Jill H., Meyer, Leah, Kshirsagar, Ravi K., Jose, Aju, Leaf, David E., and Weiner, Daniel E.

Published
2022
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25. Cardiac and Vascular Surgery–Associated Acute Kidney Injury: The 20th International Consensus Conference of the ADQI (Acute Disease Quality Initiative) Group

Author

Nadim, Mitra K, Forni, Lui G, Bihorac, Azra, Hobson, Charles, Koyner, Jay L, Shaw, Andrew, Arnaoutakis, George J, Ding, Xiaoqiang, Engelman, Daniel T, Gasparovic, Hrvoje, Gasparovic, Vladimir, Herzog, Charles A, Kashani, Kianoush, Katz, Nevin, Liu, Kathleen D, Mehta, Ravindra L, Ostermann, Marlies, Pannu, Neesh, Pickkers, Peter, Price, Susanna, Ricci, Zaccaria, Rich, Jeffrey B, Sajja, Lokeswara R, Weaver, Fred A, Zarbock, Alexander, Ronco, Claudio, and Kellum, John A

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Good Health and Well Being, Acute Kidney Injury, Cardiac Surgical Procedures, Consensus Development Conferences as Topic, Humans, Quality Improvement, Vascular Surgical Procedures, biomarker, dialysis, diuretics, ischemia-reperfusion injury, renal insufficiency, ischemia–reperfusion injury, Cardiorespiratory Medicine and Haematology, Cardiovascular medicine and haematology
Published
2018

28. Assessing the role of Chemokine (C–C motif) ligand 14 in AKI: a European consensus meeting.

Author

Koyner, Jay L., Arndt, Christian, Baldira Martinez de Irujo, Jaume, Coelho, Sílvia, Garcia-Montesinos de la Peña, Manuel, di Girolamo, Luca, Joannidis, Michael, Jorge-Monjas, Pablo, Koch, Christian, Lobaz, Steven, Meyer, Alain, Ostermann, Marlies, Pertica, Nicoletta, Prowle, John R., Silversides, Jon, Zarbock, Alexander, Echeverri, Jorge, Harenski, Kai, and Forni, Lui G.

Subjects
*ACUTE kidney failure, *RENAL replacement therapy, *LIKERT scale
Abstract

Urinary Chemokine (C–C motif) ligand 14 (CCL14) is a biomarker associated with persistent severe acute kidney injury (AKI). There is limited data to support the implementation of this AKI biomarker to guide therapeutic actions. Sixteen AKI experts with clinical CCL14 experience participated in a Delphi-based method to reach consensus on when and how to potentially use CCL14. Consensus was defined as ≥ 80% agreement (participants answered with 'Yes', or three to four points on a five-point Likert Scale). Key consensus areas for CCL14 test implementation were: identifying challenges and mitigations, developing a comprehensive protocol and pairing it with a treatment plan, and defining the target population. The majority agreed that CCL14 results can help to prioritize AKI management decisions. CCL14 levels above the high cutoff (> 13 ng/mL) significantly changed the level of concern for modifying the AKI treatment plan (p < 0.001). The highest level of concern to modify the treatment plan was for discussions on renal replacement therapy (RRT) initiation for CCL14 levels > 13 ng/mL. The level of concern for discussion on RRT initiation between High and Low, and between Medium and Low CCL14 levels, showed significant differences. Real world urinary CCL14 use appears to provide improved care options to patients at risk for persistent severe AKI. Experts believe there is a role for CCL14 in AKI management and it may potentially reduce AKI-disease burden. There is, however, an urgent need for evidence on treatment decisions and adjustments based on CCL14 results. [ABSTRACT FROM AUTHOR]

Published
2024
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30. Modulation of the Association Between Age and Death by Risk Factor Burden in Critically Ill Patients With COVID-19

Author

Sunderraj, Ashwin, Cho, Chloe, Cai, Xuan, Gupta, Shruti, Mehta, Rupal, Isakova, Tamara, Leaf, David E., Srivastava, Anand, Walther, Carl P., Anumudu, Samaya J., Arunthamakun, Justin, Kopecky, Kathleen F., Milligan, Gregory P., McCullough, Peter A., Nguyen, Thuy-Duyen, Shaefi, Shahzad, Krajewski, Megan L., Shankar, Sidharth, Pannu, Ameeka, Valencia, Juan D., Waikar, Sushrut S., Kibbelaar, Zoe A., Athavale, Ambarish M., Hart, Peter, Upadhyay, Shristi, Vohra, Ishaan, Oyintayo, Ajiboye, Green, Adam, Rachoin, Jean-Sebastien, Schorr, Christa A., Shea, Lisa, Edmonston, Daniel L., Mosher, Christopher L., Shehata, Alexandre M., Cohen, Zaza, Allusson, Valerie, Bambrick-Santoyo, Gabriela, Bhatti, Noor ul aain, Mehta, Bijal, Williams, Aquino, Brenner, Samantha K., Walters, Patricia, Go, Ronaldo C., Rose, Keith M., Hernán, Miguel A., Zhou, Amy M., Kim, Ethan C., Lisk, Rebecca, Chan, Lili, Mathews, Kusum S., Coca, Steven G., Altman, Deena R., Saha, Aparna, Soh, Howard, Hsun Wen, Huei, Bose, Sonali, Leven, Emily A., Wang, Jing G., Mosoyan, Gohar, Nadkarni, Girish N., Pattharanitima, Pattharawin, Gallagher, Emily J., Friedman, Allon N., Guirguis, John, Kapoor, Rajat, Meshberger, Christopher, Kelly, Katherine J., Parikh, Chirag R., Garibaldi, Brian T., Corona-Villalobos, Celia P., Wen, Yumeng, Menez, Steven, Malik, Rubab F., Elena Cervantes, Carmen, Gautam, Samir C., Mallappallil, Mary C., Ouyang, Jie, John, Sabu, Yap, Ernie, Melaku, Yohannes, Mohamed, Ibrahim, Bajracharya, Siddhartha, Puri, Isha, Thaxton, Mariah, Bhattacharya, Jyotsna, Wagner, John, Boudourakis, Leon, Bryant Nguyen, H., Ahoubim, Afshin, Thomas, Leslie F., Sirganagari, Dheeraj Reddy, Guru, Pramod K., Kashani, Kianoush, Tehranian, Shahrzad, Zhou, Yan, Bergl, Paul A., Rodriguez, Jesus, Shah, Jatan A., Gupta, Mrigank S., Kumar, Princy N., Lazarous, Deepa G., Kassaye, Seble G., Melamed, Michal L., Johns, Tanya S., Mocerino, Ryan, Prudhvi, Kalyan, Zhu, Denzel, Levy, Rebecca V., Azzi, Yorg, Fisher, Molly, Yunes, Milagros, Sedaliu, Kaltrina, Golestaneh, Ladan, Brogan, Maureen, Kumar, Neelja, Chang, Michael, Thakkar, Jyotsana, Raichoudhury, Ritesh, Athreya, Akshay, Farag, Mohamed, Schenck, Edward J., Cho, Soo Jung, Plataki, Maria, Alvarez-Mulett, Sergio L., Gomez-Escobar, Luis G., Pan, Di, Lee, Stefi, Krishnan, Jamuna, Whalen, William, Charytan, David, Macina, Ashley, Chaudhry, Sobaata, Wu, Benjamin, Modersitzki, Frank, Srivastava, Anand, Leidner, Alexander S., Martinez, Carlos, Kruser, Jacqueline M., Wunderink, Richard G., Hodakowski, Alexander J., Velez, Juan Carlos Q., Price-Haywood, Eboni G., Matute-Trochez, Luis A., Hasty, Anna E., Mohamed, Muner MB., Avasare, Rupali S., Zonies, David, Leaf, David E., Gupta, Shruti, Sise, Meghan E., Newman, Erik T., Abu Omar, Samah, Pokharel, Kapil K., Sharma, Shreyak, Singh, Harkarandeep, Correa, Simon, Shaukat, Tanveer, Kamal, Omer, Wang, Wei, Yang, Heather, Boateng, Jeffery O., Lee, Meghan, Strohbehn, Ian A., Li, Jiahua, Mueller, Ariel L., Redfern, Roberta E., Cairl, Nicholas S., Naimy, Gabriel, Abu-Saif, Abeer, Hall, Danyell, Bickley, Laura, Rowan, Chris, Madhani-Lovely, Farah, Cruz, Vivian S., Hess, Kristen M., Jacobs, Alanna L., Peev, Vasil, Reiser, Jochen, Byun, John J., Vissing, Andrew, Kapania, Esha M., Post, Zoe, Patel, Nilam P., Hermes, Joy-Marie, Sutherland, Anne K., Patrawalla, Amee, Finkel, Diana G., Danek, Barbara A., Arikapudi, Sowminya, Paer, Jeffrey M., Cangialosi, Peter, Liotta, Mark, Radbel, Jared, Puri, Sonika, Sunderram, Jag, Scharf, Matthew T., Ahmed, Ayesha, Berim, Ilya, Vatson, Jayanth S., Anand, Shuchi, Levitt, Joseph E., Garcia, Pablo, Boyle, Suzanne M., Song, Rui, Zhang, Jingjing, Hoon Woo, Sang, Deng, Xiaoying, Katz-Greenberg, Goni, Senter, Katharine, Sharshir, Moh’d A., Rusnak, Vadym V., Ali, Muhammad Imran, Bansal, Anip, Podoll, Amber S., Chonchol, Michel, Sharma, Sunita, Burnham, Ellen L., Douin, David J., Rashidi, Arash, Hejal, Rana, Judd, Eric, Latta, Laura, Tolwani, Ashita, Albertson, Timothy E., Adams, Jason Y., Chang, Steven Y., Beutler, Rebecca M., Schulze, Carl E., Macedo, Etienne, Rhee, Harin, Liu, Kathleen D., Jotwani, Vasantha K., Koyner, Jay L., Shah, Chintan V., Jaikaransingh, Vishal, Toth-Manikowski, Stephanie M., Joo, Min J., Lash, James P., Neyra, Javier A., Chaaban, Nourhan, Elias, Madona, Ahmad, Yahya, Iardino, Alfredo, Au, Elizabeth H., Sharma, Jill H., Anne Sosa, Marie, Taldone, Sabrina, Contreras, Gabriel, De La Zerda, David, Gershengorn, Hayley B., Shukla, Bhavarth, Fornoni, Alessia, Ferreira, Tanira, Hayek, Salim S., Blakely, Pennelope, Berlin, Hanna, Azam, Tariq U., Shadid, Husam, Pan, Michael, O’ Hayer, Patrick, Meloche, Chelsea, Feroze, Rafey, Kaakati, Rayan, Perry, Danny, Bitar, Abbas, Anderson, Elizabeth, Padalia, Kishan J., Donnelly, John P., Admon, Andrew J., Flythe, Jennifer E., Tugman, Matthew J., Chang, Emily H., Brown, Brent R., Leonberg-Yoo, Amanda K., Spiardi, Ryan C., Miano, Todd A., Roche, Meaghan S., Vasquez, Charles R., Bansal, Amar D., Ernecoff, Natalie C., Kapoor, Sanjana, Verma, Siddharth, Chen, Huiwen, Kovesdy, Csaba P., Molnar, Miklos Z., Azhar, Ambreen, Susan Hedayati, S., Nadamuni, Mridula V., Shastri, Shani, Willett, Duwayne L., Short, Samuel A.P., Renaghan, Amanda D., Enfield, Kyle B., Bhatraju, Pavan K., Bilal Malik, A., Semler, Matthew W., Vijayan, Anitha, Mariyam Joy, Christina, Li, Tingting, Goldberg, Seth, Kao, Patricia F., Schumaker, Greg L., Goyal, Nitender, Faugno, Anthony J., Schumaker, Greg L., Hsu, Caroline M., Tariq, Asma, Meyer, Leah, Kshirsagar, Ravi K., Weiner, Daniel E., Jose, Aju, Christov, Marta, Griffiths, Jennifer, Gupta, Sanjeev, Kapoor, Aromma, Wilson, Perry, Arora, Tanima, and Ugwuowo, Ugochukwu

Published
2022
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33. Controversies in acute kidney injury: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Conference

Author

Bagshaw, Sean M., Barreto, Erin F., Bihorac, Azra, Bobek, Ilona, Bouchard, Josée, Cerdá, Jorge, Chakravarthi, Rajasekara, De Rosa, Silvia, Engelman, Daniel T., Forni, Lui G., Hemmilä, Ulla K., Herzog, Charles A., Hoste, Eric A., Huen, Sarah C., Iseki, Kunitoshi, Joannidis, Michael, Kashani, Kianoush B., Koyner, Jay L., Kribben, Andreas, Lameire, Norbert, Levey, Andrew S., Macedo, Etienne, Małyszko, Jolanta, Meersch, Melanie, Mehta, Ravindra L., Mewburn, Irene, Mironova, Olga, Murray, Patrick T., Nadim, Mitra K., Pan, Jenny S., Pannu, Neesh, Peng, Zhiyong, Philips, Barbara, Ponce, Daniela, Ray, Patricio E., Ricci, Zaccaria, Rimmelé, Thomas, Ronco, Claudio, Siew, Edward D., Stevens, Paul E., Tolwani, Ashita J., Tonelli, Marcello, Vaara, Suvi T., van Dam, Marjel, Vijayan, Anitha, Wise, Michael, Wu, Vin-Cent, Zarbock, Alexander, Ostermann, Marlies, Bellomo, Rinaldo, Burdmann, Emmanuel A., Doi, Kent, Endre, Zoltan H., Goldstein, Stuart L., Kane-Gill, Sandra L., Liu, Kathleen D., Prowle, John R., Shaw, Andrew D., Srisawat, Nattachai, Cheung, Michael, Jadoul, Michel, Winkelmayer, Wolfgang C., and Kellum, John A.

Published
2020
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34. Optimizing the Design and Analysis of Future AKI Trials

Author

Legrand, Matthieu, Bagshaw, Sean M., Koyner, Jay L., Schulman, Ivonne H., Mathis, Michael R., Bernholz, Juliane, Coca, Steven, Gallagher, Martin, Gaudry, Stéphane, Liu, Kathleen D., Mehta, Ravindra L., Pirracchio, Romain, Ryan, Abigail, Steubl, Dominik, Stockbridge, Norman, Erlandsson, Fredrik, Turan, Alparslan, Wilson, F. Perry, Zarbock, Alexander, Bokoch, Michael P., Casey, Jonathan D., Rossignol, Patrick, and Harhay, Michael O.

Published
2022
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35. Clinical Use of the Urine Biomarker [TIMP-2] × [IGFBP7] for Acute Kidney Injury Risk Assessment

Author

Vijayan, Anitha, Faubel, Sarah, Askenazi, David J, Cerda, Jorge, Fissell, William H, Heung, Michael, Humphreys, Benjamin D, Koyner, Jay L, Liu, Kathleen D, Mour, Girish, Nolin, Thomas D, Bihorac, Azra, Group, American Society of Nephrology Acute Kidney Injury Advisory, Basu, Rajit K, Bhatt, Udayan Y, Connor, Michael J, Davidson, Alan J, de Caestecker, Mark P, Doi, Kent, Golestaneh, Ladan, Mour, Girish K, Singh, Prabhleen, and Thakar, Charuhas V

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Clinical Research, Prevention, Kidney Disease, 4.2 Evaluation of markers and technologies, Detection, screening and diagnosis, 4.1 Discovery and preclinical testing of markers and technologies, Renal and urogenital, Acute Kidney Injury, Biomarkers, Clinical Trials as Topic, Decision Trees, Early Diagnosis, Humans, Insulin-Like Growth Factor Binding Proteins, Risk Assessment, Tissue Inhibitor of Metalloproteinase-2, Acute kidney injury, biomarker, [TIMP-2] x [IGFBP7], diagnosis, critically ill, tissue inhibitor of metalloproteinase 2, insulin-like growth factor binding protein 7, NephroCheck, early detection, risk assessment, renal dysfunction, decreased kidney function, American Society of Nephrology Acute Kidney Injury Advisory Group, [TIMP-2] × [IGFBP7], Public Health and Health Services, Urology & Nephrology, Clinical sciences
Abstract

Acute kidney injury (AKI) is a serious complication, commonly occurring in the critically ill population, with devastating short- and long-term consequences. Despite standardization of the definition and staging of AKI, early recognition remains challenging given that serum creatinine level is a marker, albeit imperfect, of kidney function and not kidney injury. Furthermore, the delay in increase in serum creatinine level after loss of glomerular filtration also prevents timely detection of decreased kidney function in patients with AKI. During the past decade, numerous clinical investigations have evaluated the utility of several biomarkers in the early diagnosis and risk stratification of AKI. In 2014, the US Food and Drug Administration approved the marketing of a test based on the combination of urine concentrations of tissue inhibitor of metalloproteinase 2 and insulin-like growth factor binding protein 7 ([TIMP-2] × [IGFBP7]) to determine whether certain critically ill patients are at risk for developing moderate to severe AKI. The optimal role of this biomarker in the diagnosis, management, and prognosis of AKI in different clinical settings requires further clarification. In this perspective, we summarize the biological actions of these 2 cell-cycle arrest biomarkers and present important considerations regarding the clinical application, interpretation, and limitations of this novel test for the early detection of AKI.

Published
2016

36. Association of Peak Changes in Plasma Cystatin C and Creatinine With Death After Cardiac Operations

Author

Park, Meyeon, Shlipak, Michael G, Thiessen-Philbrook, Heather, Garg, Amit X, Koyner, Jay L, Coca, Steven G, Parikh, Chirag R, and Consortium, Translational Research Investigating Biomarker Endpoints in Acute Kidney Injury

Subjects
Kidney Disease, Heart Disease, Cardiovascular, Clinical Research, Renal and urogenital, Acute Kidney Injury, Adult, Aged, Aged, 80 and over, Biomarkers, Cardiac Surgical Procedures, Creatinine, Cystatin C, Female, Hospitalization, Humans, Longitudinal Studies, Male, Middle Aged, Time Factors, Translational Research Investigating Biomarker Endpoints in Acute Kidney Injury Consortium, Cardiorespiratory Medicine and Haematology, Clinical Sciences, Respiratory System
Abstract

BackgroundAcute kidney injury is a risk factor for death in cardiac surgical patients. Plasma cystatin C and creatinine have different temporal profiles in the postoperative setting, but the associations of simultaneous changes in both filtration markers compared with change in only one marker with prognosis after hospital discharge are not well described.MethodsThis is a longitudinal study of 1,199 high-risk adult cardiac surgical patients in the TRIBE-AKI (Translational Research Investigating Biomarker Endpoints for Acute Kidney Injury) Consortium who survived hospitalization. We examined in-hospital peak changes of cystatin C and creatinine in the 3 days after cardiac operations. We evaluated associations of these filtration markers with death, adjusting for demographics, operative characteristics, medical comorbidities, preoperative estimated glomerular filtration rate, preoperative urinary albumin-to-creatinine ratio, and site.ResultsDuring the first 3 days of hospitalization, nearly twice as many patients had a 25% or higher rise in creatinine (30%) compared with a 25% or higher peak rise in cystatin C (15%). The risk of death was higher in those with elevations in cystatin C (adjusted hazard ratio [HR], 1.83; 95% confidence interval [CI], 1.4 to 2.37) or creatinine (adjusted HR, 1.90; 95% CI, 1.32 to 2.72) compared with patients who experienced a postoperative decrease in either filtration marker. Patients who had simultaneous elevations of 25% or higher in cystatin C and creatinine were at similar adjusted risk for 3-year mortality (HR, 1.79; 95% CI, 1.03 to 3.1) as those with a 25% or higher increase in cystatin C alone (HR, 2.2; 95% CI, 1.09 to 4.47).ConclusionsElevations in creatinine postoperatively are more common than elevations in cystatin C. However, elevations in cystatin C appeared to be associated with a higher risk of death after hospital discharge.

Published
2016

37. Urine Biomarkers and Perioperative Acute Kidney Injury: The Impact of Preoperative Estimated GFR

Author

Koyner, Jay L, Coca, Steven G, Thiessen-Philbrook, Heather, Patel, Uptal D, Shlipak, Michael G, Garg, Amit X, Parikh, Chirag R, Consortium, Translational Research Investigating Biomarker Endpoints for Acute Kidney Injury, Raman, Jai, Jeevanandam, Valluvan, Akhter, Shahab, Devarajan, Prasad, Bennett, Michael, Ma, Qing, Griffiths, Rachel, Edelstein, Charles, Passik, Cary, Nagy, Judy, Swaminathan, Madhav, Chu, Michael, Goldbach, Martin, Guo, Lin Ruo, McKenzie, Neil, Myers, Mary Lee, Novick, Richard, Quantz, Mac, Schumann, Virginia, Webster, Laura, Zappitelli, Michael, Palijan, Ana, Dewar, Michael, Darr, Umer, Hashim, Sabet, Elefteriades, John, Geirsson, Arnar, Garwood, Susan, Kemp, Rowena, and Butrymowicz, Isabel

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Kidney Disease, Clinical Research, Renal and urogenital, Acute Kidney Injury, Aged, Aged, 80 and over, Biomarkers, Cardiac Surgical Procedures, Cohort Studies, Creatinine, Cystatin C, Female, Glomerular Filtration Rate, Humans, Male, Middle Aged, Postoperative Complications, Prospective Studies, Urine biomarkers, interleukin 18, liver-type fatty acid binding protein, acute renal failure, acute kidney injury, perioperative AKI, effect modification, estimated glomerular filtration rate, prognosis, cardiac surgery, surgical complication, Translational Research Investigating Biomarker Endpoints for Acute Kidney Injury (TRIBE-AKI) Consortium, Translational Research Investigating Biomarker Endpoints for Acute Kidney Injury TRIBE-AKI Consortium, Public Health and Health Services, Urology & Nephrology, Clinical sciences
Abstract

BackgroundThe interaction between baseline kidney function and the performance of biomarkers of acute kidney injury (AKI) on the development of AKI is unclear.Study designPost hoc analysis of prospective cohort study.Setting & participantsThe 1,219 TRIBE-AKI Consortium adult cardiac surgery cohort participants.PredictorUnadjusted postoperative urinary biomarkers of AKI measured within 6 hours of surgery.OutcomeAKI was defined as AKI Network stage 1 (any AKI) or higher, as well as a doubling of serum creatinine level from the preoperative value or the need for post-operative dialysis (severe AKI).MeasurementsStratified analyses by preoperative estimated glomerular filtration rate (eGFR) ≤ 60 versus > 60mL/min/1.73m(2).Results180 (42%) patients with preoperative eGFRs≤60mL/min/1.73m(2) developed clinical AKI compared with 246 (31%) of those with eGFRs>60mL/min/1.73m(2) (P

Published
2015

38. Patient-provider communications about pharmacogenomic results increase patient recall of medication changes

Author

Borden, Brittany A., Lee, Sang Mee, Danahey, Keith, Galecki, Paige, Patrick-Miller, Linda, Siegler, Mark, Sorrentino, Matthew J., Sacro, Yasmin, Davis, Andrew M., Rubin, David T., Lipstreuer, Kristen, Polonsky, Tamar S., Nanda, Rita, Harper, William R., Koyner, Jay L., Burnet, Deborah L., Stadler, Walter M., Kavitt, Robert T., Meltzer, David O., Ratain, Mark J., and O’Donnell, Peter H.

Published
2019
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41. Association Between Preoperative Statin Use and Acute Kidney Injury Biomarkers in Cardiac Surgical Procedures

Author

Molnar, Amber O, Parikh, Chirag R, Coca, Steven G, Thiessen-Philbrook, Heather, Koyner, Jay L, Shlipak, Michael G, Myers, Mary Lee, Garg, Amit X, and Consortium, TRIBE-AKI

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Heart Disease, Clinical Research, Kidney Disease, Cardiovascular, 6.1 Pharmaceuticals, Evaluation of treatments and therapeutic interventions, Renal and urogenital, Good Health and Well Being, Acute Kidney Injury, Acute-Phase Proteins, Adult, Aged, Biomarkers, Cardiac Surgical Procedures, Cohort Studies, Female, Hepatitis A Virus Cellular Receptor 1, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Interleukin-18, Lipocalin-2, Lipocalins, Male, Membrane Glycoproteins, Middle Aged, Prospective Studies, Proto-Oncogene Proteins, Receptors, Virus, TRIBE-AKI Consortium, Cardiorespiratory Medicine and Haematology, Respiratory System, Cardiovascular medicine and haematology, Clinical sciences
Abstract

BackgroundAcute kidney injury (AKI) is a serious complication of cardiac operations for which there remains no specific therapy. Animal data and several observational studies suggest that statins prevent AKI, but the results are not conclusive, and many studies are retrospective in nature.MethodsWe conducted a multicenter prospective cohort study of 625 adult patients undergoing elective cardiac operations. All patients were taking statins and were grouped according to whether statins were continued or held in the 24 hours before operation. The primary outcome was AKI as defined by a doubling of serum creatinine or dialysis. The secondary outcome was the peak level of several kidney injury biomarkers. The results were adjusted for demographic and clinical factors.ResultsContinuing (vs holding) a statin before operation was not associated with a lower risk of AKI, as defined by a doubling of serum creatinine or dialysis (adjusted relative risk [RR] 1.09; 95% confidence interval [CI] 0.44, 2.70). However, continuing a statin was associated with a lower risk of elevation of the following AKI biomarkers: urine interleukin-18, urine neutrophil gelatinase-associated lipocalin, urine kidney injury molecule-1, and plasma neutrophil gelatinase-associated lipocalin (adjusted RR 0.34; 95% CI 0.18, 0.62), (adjusted RR 0.41; 95% CI 0.22, 0.76), (adjusted RR 0.37; 95% CI 0.20, 0.76), (adjusted RR 0.62; 95% CI 0.39, 0.98), respectively.ConclusionsStatins may prevent kidney injury after cardiac operations, as evidenced by lower levels of kidney injury biomarkers.

Published
2014

42. Validation of Cell-Cycle Arrest Biomarkers for Acute Kidney Injury Using Clinical Adjudication

Author

Bihorac, Azra, Chawla, Lakhmir S, Shaw, Andrew D, Al-Khafaji, Ali, Davison, Danielle L, DeMuth, George E, Fitzgerald, Robert, Gong, Michelle Ng, Graham, Derrel D, Gunnerson, Kyle, Heung, Michael, Jortani, Saeed, Kleerup, Eric, Koyner, Jay L, Krell, Kenneth, LeTourneau, Jennifer, Lissauer, Matthew, Miner, James, Nguyen, H Bryant, Ortega, Luis M, Self, Wesley H, Sellman, Richard, Shi, Jing, Straseski, Joely, Szalados, James E, Wilber, Scott T, Walker, Michael G, Wilson, Jason, Wunderink, Richard, Zimmerman, Janice, and Kellum, John A

Subjects
Clinical Research, Kidney Disease, 4.2 Evaluation of markers and technologies, Detection, screening and diagnosis, Renal and urogenital, Acute Kidney Injury, Aged, Aged, 80 and over, Biomarkers, Cell Death, Cohort Studies, Critical Illness, Female, Humans, Insulin-Like Growth Factor Binding Proteins, Male, Middle Aged, Predictive Value of Tests, Prospective Studies, Protease Inhibitors, Sensitivity and Specificity, Severity of Illness Index, Time Factors, Tissue Inhibitor of Metalloproteinase-2, United States, acute kidney injury, biomarkers, cell-cycle arrest, tissue inhibitor of metalloproteinases-2, insulin-like growth factor binding protein 7, Medical and Health Sciences, Respiratory System
Abstract

RationaleWe recently reported two novel biomarkers for acute kidney injury (AKI), tissue inhibitor of metalloproteinases (TIMP)-2 and insulin-like growth factor binding protein 7 (IGFBP7), both related to G1 cell cycle arrest.ObjectivesWe now validate a clinical test for urinary [TIMP-2]·[IGFBP7] at a high-sensitivity cutoff greater than 0.3 for AKI risk stratification in a diverse population of critically ill patients.MethodsWe conducted a prospective multicenter study of 420 critically ill patients. The primary analysis was the ability of urinary [TIMP-2]·[IGFBP7] to predict moderate to severe AKI within 12 hours. AKI was adjudicated by a committee of three independent expert nephrologists who were masked to the results of the test.Measurements and main resultsUrinary TIMP-2 and IGFBP7 were measured using a clinical immunoassay platform. The primary endpoint was reached in 17% of patients. For a single urinary [TIMP-2]·[IGFBP7] test, sensitivity at the prespecified high-sensitivity cutoff of 0.3 (ng/ml)(2)/1,000 was 92% (95% confidence interval [CI], 85-98%) with a negative likelihood ratio of 0.18 (95% CI, 0.06-0.33). Critically ill patients with urinary [TIMP-2]·[IGFBP7] greater than 0.3 had seven times the risk for AKI (95% CI, 4-22) compared with critically ill patients with a test result below 0.3. In a multivariate model including clinical information, urinary [TIMP-2]·[IGFBP7] remained statistically significant and a strong predictor of AKI (area under the curve, 0.70, 95% CI, 0.63-0.76 for clinical variables alone, vs. area under the curve, 0.86, 95% CI, 0.80-0.90 for clinical variables plus [TIMP-2]·[IGFBP7]).ConclusionsUrinary [TIMP-2]·[IGFBP7] greater than 0.3 (ng/ml)(2)/1,000 identifies patients at risk for imminent AKI. Clinical trial registered with www.clinicaltrials.gov (NCT 01573962).

Published
2014

46. Machine Learning Prediction of Death in Critically Ill Patients With Coronavirus Disease 2019

Author

Churpek, Matthew M., Gupta, Shruti, Spicer, Alexandra B., Hayek, Salim S., Srivastava, Anand, Chan, Lili, Melamed, Michal L., Brenner, Samantha K., Radbel, Jared, Madhani-Lovely, Farah, Bhatraju, Pavan K., Bansal, Anip, Green, Adam, Goyal, Nitender, Shaefi, Shahzad, Parikh, Chirag R., Semler, Matthew W., Leaf, David E., Walther, Carol P., Anumudu, Samaya J., Arunthamakun, Justin, Kopecky, Kathleen F., Milligan, Gregory P., McCullough, Peter A., Nguyen, ThuyDuyen, Shaefi, Shahzad, Krajewski, Megan L., Shankar, Sidharth, Pannu, Ameeka, Valencia, Juan D., Waikar, Sushrut S., Kibbelaar, Zoe A., Athavale, Ambarish M., Hart, Peter, Ajiboye, Oyintayo, Itteera, Matthew, Green, Adam, Rachoin, Jean-Sebastien, Schorr, Christa A., Shea, Lisa, Edmonston, Daniel L., Mosher, Christopher L., Shehata, Alexandre M., Cohen, Zaza, Allusson, Valerie, Bambrick-Santoyo, Gabriela, Bhatti, Noor ul aain, Metha, Bijal, Williams, Aquino, Brenner, Samantha K., Walters, Patricia, Go, Ronaldo C., Rose, Keith M., Hernán, Miguel A., Zhou, Amy M., Kim, Ethan C., Lisk, Rebecca, Chan, Lili, Mathews, Kusum S., Coca, Steven G., Altman, Deena R., Saha, Aparna, Soh, Howard, Wen, Huei Hsun, Bose, Sonali, Leven, Emily, Wang, Jing G., Mosoyan, Gohar, Nadkarni, Girish N., Friedman, Allon N., Guirguis, John, Kapoor, Rajat, Meshberger, Christopher, Parikh, Chirag R., Garibaldi, Brian T., Corona-Villalobos, Celia P., Wen, Yumeng, Menez, Steven, Malik, Rubab F., Cervantes, Carmen Elena, Gautam, Samir C., Chang, Crystal, Nguyen, H. Bryant, Ahoubim, Afshin, Thomas, Leslie F., Guru, Pramod K., Bergl, Paul A., Zhou, Yan, Rodriguez, Jesus, Shah, Jatan A., Gupta, Mrigank S., Kumar, Princy N., Lazarous, Deepa G., Kassaye, Seble G., Melamed, Michal L., Johns, Tanya S., Mocerino, Ryan, Prudhvi, Kalyan, Zhu, Denzel, Levy, Rebecca V., Azzi, Yorg, Fisher, Molly, Yunes, Milagros, Sedaliu, Kaltrina, Golestaneh, Ladan, Brogan, Maureen, Thakkar, Jyotsana, Kumar, Neelja, Ross, Michael J., Chang, Michael, Raichoudhury, Ritesh, Schenck, Edward J., Cho, Soo Jung, Plataki, Maria, Alvarez-Mulett, Sergio L., Gomez-Escobar, Luis G., Pan, Di, Lee, Stefi, Krishnan, Jamuna, Whalen, William, Charytan, David, Macina, Ashley, Ross, Daniel W., Srivastava, Anand, Leidner, Alexander S., Martinez, Carlos, Kruser, Jacqueline M., Wunderink, Richard G., Hodakowski, Alexander J., Velez, Juan Carlos Q., Price-Haywood, Eboni G., Matute-Trochez, Luis A., Hasty, Anna E., Mohamed, Muner MB., Avasare, Rupali S., Zonies, David, Leaf, David E., Gupta, Shruti, Baron, Rebecca M., Sise, Meghan E., Newman, Erik T., Omar, Samah Abu, Pokharel, Kapil K., Sharma, Shreyak, Singh, Harkarandeep, Gaviria, Simon Correa, Shaukat, Tanveer, Kamal, Omer, Wang, Wei, Yang, Heather, Boateng, Jeffery O., Lee, Meghan, Strohbehn, Ian A., Li, Jiahua, Muhsin, Saif A., Mandel, Ernest I., Mueller, Ariel L., Cairl, Nicholas S., Madhani-Lovely, Farah, Rowan, Chris, Madhai-Lovely, Farah, Peev, Vasil, Reiser, Jochen, Byun, John J., Vissing, Andrew, Kapania, Esha M., Post, Zoe, Patel, Nilam P., Hermes, Joy-Marie, Sutherland, Anne K., Patrawalla, Amee, Finkel, Diana G., Danek, Barbara A., Arikapudi, Sowminya, Paer, Jeffrey M., Radbel, Jared, Puri, Sonika, Sunderram, Jag, Scharf, Matthew T., Ahmed, Ayesha, Berim, Ilya, Vatson, Jayanth, Anand, Shuchi, Levitt, Joseph E., Garcia, Pablo, Boyle, Suzanne M., Song, Rui, Zhang, Jingjing, Sharshir, Moh’d A., Rusnak, Vadym V., Bansal, Anip, Podoll, Amber S., Chonchol, Michel, Sharma, Sunita, Burnham, Ellen L., Rashidi, Arash, Hejal, Rana, Judd, Eric, Latta, Laura, Tolwani, Ashita, Albertson, Timothy E., Adams, Jason Y., Chang, Steven Y., Beutler, Rebecca M., Schulze, Carl E., Macedo, Etienne, Rhee, Harin, Liu, Kathleen D., Jotwani, Vasantha K., Koyner, Jay L., Shah, Chintan V., Jaikaransingh, Vishal, Toth-Manikowski, Stephanie M., Joo, Min J., Lash, James P., Neyra, Javier A., Chaaban, Nourhan, Iardino, Alfredo, Au, Elizabeth H., Sharma, Jill H., Anne Sosa, Marie, Taldone, Sabrina, Contreras, Gabriel, De La Zerda, David, Gershengorn, Hayley B., Hayek, Salim S., Blakely, Pennelope, Berlin, Hanna, Azam, Tariq U., Shadid, Husam, Pan, Michael, Hayer, Patrick O’, Meloche, Chelsea, Feroze, Rafey, Padalia, Kishan J., Leya, Jeff, Donnelly, John P., Admon, Andrew J., Flythe, Jennifer E., Tugman, Matthew J., Brown, Brent R., Leonberg-Yoo, Amanda K., Spiardi, Ryan C., Miano, Todd A., Roche, Meaghan S., Vasquez, Charles R., Bansal, Amar D., Ernecoff, Natalie C., Kovesdy, Csaba P., Molnar, Miklos Z., Hedayati, S. Susan, Nadamuni, Mridula V., Khan, Sadaf S., Willett, Duwayne L., Short, Samuel A.P., Renaghan, Amanda D., Bhatraju, Pavan, Malik, A. Bilal, Semler, Matthew W., Vijayan, Anitha, Mariyam Joy, Christina, Li, Tingting, Goldberg, Seth, Kao, Patricia F., Schumaker, Greg L., Goyal, Nitender, Faugno, Anthony J., Schumaker, Greg L., Hsu, Caroline M., Tariq, Asma, Meyer, Leah, Christov, Marta, Wilson, Francis P., Arora, Tanima, and Ugwuowo, Ugochukwu

Published
2021
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48. Urinary Cystatin C and Acute Kidney Injury After Cardiac Surgery

Author

Koyner, Jay L, Garg, Amit X, Shlipak, Michael G, Patel, Uptal D, Sint, Kyaw, Hong, Kwangik, Devarajan, Prasad, Edelstein, Charles L, Zappitelli, Michael, Thiessen-Philbrook, Heather, Parikh, Chirag R, and Consortium, Translational Research Investigating Biomarker Endpoints in AKI

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Patient Safety, Kidney Disease, Cardiovascular, Pediatric, Heart Disease, Clinical Research, Detection, screening and diagnosis, 4.2 Evaluation of markers and technologies, Evaluation of treatments and therapeutic interventions, 6.1 Pharmaceuticals, Renal and urogenital, Acute Kidney Injury, Adolescent, Adult, Aged, Biomarkers, Cardiac Surgical Procedures, Child, Child, Preschool, Creatinine, Cystatin C, Female, Follow-Up Studies, Glomerular Filtration Rate, Heart Diseases, Humans, Kidney Function Tests, Male, Middle Aged, Postoperative Complications, Prognosis, Prospective Studies, Risk Factors, Young Adult, Acute kidney injury biomarkers, cystatin C, dialysis, perioperative, Translational Research Investigating Biomarker Endpoints in AKI (TRIBE AKI) Consortium, Public Health and Health Services, Urology & Nephrology, Clinical sciences
Abstract

BackgroundAcute kidney injury (AKI) is common after cardiac surgery and is associated with adverse patient outcomes. Urinary cystatin C (CysC) level is a biomarker of proximal tubule function and may increase earlier in AKI than serum creatinine level.Study designProspective cohort study.Settings & participantsThe TRIBE AKI (Translational Research Investigating Biomarker Endpoints in AKI) Consortium prospectively enrolled 1,203 adults and 299 children and adolescents at 8 institutions in 2007-2009.Index testUrinary CysC (in milligrams per liter) within the first 12 hours after surgery.OutcomeSerum creatinine-based AKI was defined as AKI Network stage 1 (mild AKI) and doubling of serum creatinine from the preoperative value or need for dialysis during hospitalization (severe AKI).Other measurementsAnalyses were adjusted for characteristics used clinically for AKI risk stratification, including age, sex, race, estimated glomerular filtration rate, diabetes, hypertension, heart failure, nonelective surgery, cardiac catheterization within 72 hours, type of surgery, myocardial infarction, and cardiopulmonary bypass time longer than 120 minutes.ResultsUrinary CysC level measured in the early postoperative period (0-6 and 6-12 hours postoperatively) correlated with both mild and severe AKI in adults and children. However, after analyses were adjusted for other factors, the effect was attenuated for both forms of AKI in both cohorts.LimitationsLimited numbers of patients with severe AKI and in-hospital dialysis treatment.ConclusionsUrinary CysC values are not associated significantly with the development of AKI after cardiac surgery in adults and children.

Published
2013

49. Discovery and validation of cell cycle arrest biomarkers in human acute kidney injury

Author

Kashani, Kianoush, Al-Khafaji, Ali, Ardiles, Thomas, Artigas, Antonio, Bagshaw, Sean M, Bell, Max, Bihorac, Azra, Birkhahn, Robert, Cely, Cynthia M, Chawla, Lakhmir S, Davison, Danielle L, Feldkamp, Thorsten, Forni, Lui G, Gong, Michelle, Gunnerson, Kyle J, Haase, Michael, Hackett, James, Honore, Patrick M, Hoste, Eric AJ, Joannes-Boyau, Olivier, Joannidis, Michael, Kim, Patrick, Koyner, Jay L, Laskowitz, Daniel T, Lissauer, Matthew E, Marx, Gernot, McCullough, Peter A, Mullaney, Scott, Ostermann, Marlies, Rimmelé, Thomas, Shapiro, Nathan I, Shaw, Andrew D, Shi, Jing, Sprague, Amy M, Vincent, Jean-Louis, Vinsonneau, Christophe, Wagner, Ludwig, Walker, Michael G, Wilkerson, R Gentry, Zacharowski, Kai, and Kellum, John A

Abstract

Abstract Introduction Acute kidney injury (AKI) can evolve quickly and clinical measures of function often fail to detect AKI at a time when interventions are likely to provide benefit. Identifying early markers of kidney damage has been difficult due to the complex nature of human AKI, in which multiple etiologies exist. The objective of this study was to identify and validate novel biomarkers of AKI. Methods We performed two multicenter observational studies in critically ill patients at risk for AKI - discovery and validation. The top two markers from discovery were validated in a second study (Sapphire) and compared to a number of previously described biomarkers. In the discovery phase, we enrolled 522 adults in three distinct cohorts including patients with sepsis, shock, major surgery, and trauma and examined over 300 markers. In the Sapphire validation study, we enrolled 744 adult subjects with critical illness and without evidence of AKI at enrollment; the final analysis cohort was a heterogeneous sample of 728 critically ill patients. The primary endpoint was moderate to severe AKI (KDIGO stage 2 to 3) within 12 hours of sample collection. Results Moderate to severe AKI occurred in 14% of Sapphire subjects. The two top biomarkers from discovery were validated. Urine insulin-like growth factor-binding protein 7 (IGFBP7) and tissue inhibitor of metalloproteinases-2 (TIMP-2), both inducers of G1 cell cycle arrest, a key mechanism implicated in AKI, together demonstrated an AUC of 0.80 (0.76 and 0.79 alone). Urine [TIMP-2]·[IGFBP7] was significantly superior to all previously described markers of AKI (P 0.72. Furthermore, [TIMP-2]·[IGFBP7] significantly improved risk stratification when added to a nine-variable clinical model when analyzed using Cox proportional hazards model, generalized estimating equation, integrated discrimination improvement or net reclassification improvement. Finally, in sensitivity analyses [TIMP-2]·[IGFBP7] remained significant and superior to all other markers regardless of changes in reference creatinine method. Conclusions Two novel markers for AKI have been identified and validated in independent multicenter cohorts. Both markers are superior to existing markers, provide additional information over clinical variables and add mechanistic insight into AKI. Trial registration ClinicalTrials.gov number NCT01209169.

Published
2013

50. Serum Cystatin C– Versus Creatinine-Based Definitions of Acute Kidney Injury Following Cardiac Surgery: A Prospective Cohort Study

Author

Spahillari, Aferdita, Parikh, Chirag R, Sint, Kyaw, Koyner, Jay L, Patel, Uptal D, Edelstein, Charles L, Passik, Cary S, Thiessen-Philbrook, Heather, Swaminathan, Madhav, Shlipak, Michael G, and Consortium, TRIBE-AKI

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Cardiovascular, Clinical Research, Prevention, Kidney Disease, 4.2 Evaluation of markers and technologies, Detection, screening and diagnosis, Renal and urogenital, Good Health and Well Being, Acute Kidney Injury, Aged, Aged, 80 and over, Biomarkers, Cardiac Surgical Procedures, Cohort Studies, Creatinine, Cystatin C, Female, Hospital Mortality, Humans, Male, Middle Aged, Postoperative Complications, Prospective Studies, Risk Factors, Perioperative, acute renal failure, diagnosis, creatinine, TRIBE-AKI Consortium, Public Health and Health Services, Urology & Nephrology, Clinical sciences
Abstract

BackgroundThe primary aim of this study was to compare the sensitivity and rapidity of acute kidney injury (AKI) detection by cystatin C level relative to creatinine level after cardiac surgery.Study designProspective cohort study.Settings & participants1,150 high-risk adult cardiac surgery patients in the TRIBE-AKI (Translational Research Investigating Biomarker Endpoints for Acute Kidney Injury) Consortium.PredictorChanges in serum creatinine and cystatin C levels.OutcomePostsurgical incidence of AKI.MeasurementsSerum creatinine and cystatin C were measured at the preoperative visit and daily on postoperative days 1-5. To allow comparisons between changes in creatinine and cystatin C levels, AKI end points were defined by the relative increases in each marker from baseline (25%, 50%, and 100%) and the incidence of AKI was compared based on each marker. Secondary aims were to compare clinical outcomes among patients defined as having AKI by cystatin C and/or creatinine levels.ResultsOverall, serum creatinine level detected more cases of AKI than cystatin C level: 35% developed a ≥25% increase in serum creatinine level, whereas only 23% had a ≥25% increase in cystatin C level (P < 0.001). Creatinine level also had higher proportions meeting the 50% (14% and 8%; P < 0.001) and 100% (4% and 2%; P = 0.005) thresholds for AKI diagnosis. Clinical outcomes generally were not statistically different for AKI cases detected by creatinine or cystatin C level. However, for each AKI threshold, patients with AKI confirmed by both markers had a significantly higher risk of the combined mortality/dialysis outcome compared with patients with AKI detected by creatinine level alone (P = 0.002).LimitationsThere were few adverse clinical outcomes, limiting our ability to detect differences in outcomes between subgroups of patients based on their definitions of AKI.ConclusionsIn this large multicenter study, we found that cystatin C level was less sensitive for AKI detection than creatinine level. However, confirmation by cystatin C level appeared to identify a subset of patients with AKI with a substantially higher risk of adverse outcomes.

Published
2012

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