Acute Kidney Injury, Critical Illness, Kidney Failure
Conditions
Brief summary
The aim of this study was to identify and validate novel biomarkers for predict acute kidney injury (AKI) subphenotype, major adverse kidney events and other poor outcomes.
Detailed description
Cardiac surgery-associated acute kidney injury (CSA-AKI) is a serious condition that is associated with increased mortality and morbidity. However, the current criteria for assessing the severity of AKI may not adequately capture the heterogeneity of this condition. This can lead to difficulties in identifying treatment effects in specific patient subgroups, which may contribute to the growing number of negative interventional trials in AKI. To address this issue, researchers have developed and validated two subphenotypes of AKI: resolving and nonresolving. These subphenotypes are based on the trajectory of serum creatinine (SCr) levels in the first 3 days after hospital presentation. By stratifying AKI patients based on these subphenotypes, we can better assess their risk and predict outcomes. Several novel biomarkers have been developed to aid in the early detection of AKI, discrimination of its underlying causes, and prediction of outcomes. However, it remains unclear whether these biomarkers can accurately predict the development of a nonresolving AKI subphenotype. In our present study, we aim to address this gap in knowledge by conducting a large cohort study. Our goal is to identify and validate novel biomarkers that can effectively detect the resolving subphenotype of AKI, as well as predict major adverse kidney events and other poor outcomes.
Interventions
None listed
Sponsors
Zhongshan Hospital (Xiamen), Fudan University
Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University
Shanghai Zhongshan Hospital
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Inclusion criteria
* Patients undergoing cardiac surgery who experienced AKI within 48 hours of cardiac surgery were screened.
Exclusion criteria
* History of End Stage Renal Disease or on Dialysis; * prior kidney transplantation; * patients with a DNR order; * patients without written informed consent; * pregnancy; * moribund patients with expected death within 24 h or whose survival to 28 days was unlikely due to an uncontrollable comorbidity (i.e., end-stage liver or heart disease, untreatable malignancy)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| AKI nonresolving subphenotype | 7 days | The resolving subphenotype was defined by a decrease of 0.3 mg/dl or 25% in SCr from its maximum during the first 3 days of study enrollment. All subjects with AKI who did not meet this criterion were classified as having a nonresolving subphenotype |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Major adverse kidney events at 90 days | 90 days | MAKE was defined as the composite of≥25% loss in estimated glomerular filtration rate (eGFR), dialysis, or death. Estimated GFR was calculated from serum creatinine using the MDRD equation. |
| Major adverse kidney events at 365 days | 365 days | MAKE was defined as the composite of≥25% loss in estimated glomerular filtration rate (eGFR), dialysis, or death. Estimated GFR was calculated from serum creatinine using the modification of diet in renal disease (MDRD) equation. |
| Mortality | 365 days | Mortality at 30 days, 90 days and 365 days |
| Major adverse kidney events at 30 days | 30 days | Major adverse kidney events (MAKE) was defined as the composite of≥25% loss in estimated glomerular filtration rate (eGFR), dialysis, or death. Estimated GFR was calculated from serum creatinine using the MDRD equation. |
| Moderate and severe AKI | 7 days | Kidney Disease Improving Global Outcomes (KDIGO) stage 2 or stage 3 |
| AKI progression | 7 days | worsening of KDIGO stage within 1 week (progressing from stage 1 to either stage 2 or stage 3, or from stage 2 to stage 3). Patients diagnosed with progressive or persisting stage 3 AKI (stage 3 AKI for \>3 consecutive days) were classified as having AKI progression. If patients who presented with stage 3 AKI but not requiring RRT subsequently required dialysis or developing persist severe AKI or death within 7 days, this was considered progression. |
| Composite Outcome | 30 days | Stage 3 AKI, renal replacement therapy or death through outpatient or telephone follow-up |
| Receipt of renal replacement treatment | 365 days | Patients received renal replacement treatment during hospital stay |
Countries
China
Contacts
Primary ContactYing Su, Dr.
Outcome results
None listed