title: Association of postoperative proteinuria with AKI after cardiac surgery among patients at high risk.
abstract: OBJECTIVE
  Preoperative proteinuria is associated with a higher incidence of postoperative AKI. Whether the same is true for postoperative proteinuria is uncertain. This study tested the hypothesis that increased proteinuria after cardiac surgery is associated with an increased risk for AKI.
  
  
  METHODS
  This prospective cohort study included 1198 adults undergoing cardiac surgery at six hospitals between July 2007 and December 2009. Albuminuria, urine albumin-to-creatinine ratio (ACR), and dipstick proteinuria were measured 0-6 hours after surgery. The primary outcome was AKI, defined as a doubling in serum creatinine or receipt of acute dialysis during the hospital stay. Analyses were adjusted for patient characteristics, including preoperative albuminuria.
  
  
  RESULTS
  Compared with the lowest quintile, the highest quintile of albuminuria and highest grouping of dipstick proteinuria were associated with greatest risk for AKI (adjusted relative risks [RRs], 2.97 [95% confidence interval (CI), 1.20-6.91] and 2.46 [95% CI, 1.16-4.97], respectively). Higher ACR was not associated with AKI risk (highest quintile RR, 1.66 [95% CI, 0.68-3.90]). Of the three proteinuria measures, early postoperative albuminuria improved the prediction of AKI to the greatest degree (clinical model area under the curve, 0.75; 0.81 with albuminuria). Similar improvements with albuminuria were seen for net reclassification index (0.55; P<0.001) and integrated discrimination index (0.036; P<0.001).
  
  
  CONCLUSIONS
  Higher levels of proteinuria after cardiac surgery identify patients at increased risk for AKI during their hospital stay.
authors.affiliation: Division of Nephrology, Department of Medicine, University of Western Ontario, London, Ontario, Canada.
authors.forename: Amber O
authors.initials: AO
authors.lastname: Molnar
authors.forename: Chirag R
authors.initials: CR
authors.lastname: Parikh
authors.forename: Kyaw
authors.initials: K
authors.lastname: Sint
authors.forename: Steven G
authors.initials: SG
authors.lastname: Coca
authors.forename: Jay
authors.initials: J
authors.lastname: Koyner
authors.forename: Uptal D
authors.initials: UD
authors.lastname: Patel
authors.forename: Isabel
authors.initials: I
authors.lastname: Butrymowicz
authors.forename: Michael
authors.initials: M
authors.lastname: Shlipak
authors.forename: Amit X
authors.initials: AX
authors.lastname: Garg
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology*; D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000209:etiology; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D015331:Cohort Studies; D003404:Creatinine / Q000652:urine; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D011446:Prospective Studies; D011507:Proteinuria / Q000209:etiology*; D012306:Risk
chemical_list: D003404:Creatinine