Kinetic eGFR and Novel AKI Biomarkers to Predict Renal Recovery.
OBJECTIVE
Prompt recognition of severe renal impairment could improve the early management of critically ill patients. We compared the value of kinetic eGFR, plasma neutrophil gelatinase-associated lipocalin (NGAL), and urine tissue inhibitor of metalloproteinase-2 and urine insulin-like growth factor-binding protein 7 ([TIMP-2]*[IGFBP7]) in predicting short-term recovery from AKI and major adverse kidney events.


METHODS
During the 6-month study period, 245 patients were admitted to our intensive care unit. This study included 57 consecutive patients presenting with AKI within the first 24 hours after admission. AKI markers were evaluated at inclusion (day 0) and 24 hours later (day 1). Kinetic eGFR was calculated on day 1 according to serum creatinine evolution. Renal recovery was defined as normalization of serum creatinine with reversal of oliguria within 48 hours. Major adverse kidney events included death, need for RRT, or persistence of renal dysfunction at hospital discharge.


RESULTS
Plasma NGAL and [TIMP-2]*[IGFBP7] predicted renal recovery, with area under the receiver-operating characteristic curve (AUC-ROC) values between 0.70 and 0.79 at inclusion. Although plasma NGAL values frequently reached the maximal measurement range, their decrease on day 1 predicted recovery. The kinetic eGFR calculation after initial resuscitation provided the best AUC-ROC value for renal recovery, at 0.87. The best predictions for major adverse kidney events were provided by [TIMP-2]*[IGFBP7] and kinetic eGFR (equal AUC-ROCs of 0.81). Combining AKI markers in addition to clinical prediction models improved the discrimination and reclassification of patients who will recover from AKI or suffer from major adverse kidney events.


CONCLUSIONS
Biomarkers of kidney damage predicted short-term renal recovery and major adverse kidney events for an unselected cohort of critically ill patients. Calculating the kinetic eGFR imposed a delay after initial resuscitation but provided a good diagnostic and prognostic approach. The utility of functional and damage AKI marker combinations in addition to clinical information requires validation in larger prospective studies.
Departments of Anesthesia and Intensive Care II, French Institute of Health and Medical Research (INSERM) U1026, Tissue Bioengineering (BioTis), University of Bordeaux, Bordeaux, France; antoine.dewitte@chu-bordeaux.fr.
Antoine
A
Dewitte
Departments of Anesthesia and Intensive Care II.
Olivier
O
Joannès-Boyau
Departments of Anesthesia and Intensive Care II.
Carole
C
Sidobre
Departments of Anesthesia and Intensive Care II.
Catherine
C
Fleureau
Biochemistry, and.
Marie-Lise
ML
Bats
Biochemistry, and.
Philippe
P
Derache
Biofortis, Mérieux NutriSciences Company, Saint-Herblain, France; and.
Sébastien
S
Leuillet
French Institute of Health and Medical Research (INSERM) U1026, Tissue Bioengineering (BioTis), University of Bordeaux, Bordeaux, France;
Jean
J
Ripoche
French Institute of Health and Medical Research (INSERM) U1026, Tissue Bioengineering (BioTis), University of Bordeaux, Bordeaux, France; Nephrology, Transplantation, Dialysis, University Hospital, Bordeaux, France;
Christian
C
Combe
Departments of Anesthesia and Intensive Care II, INSERM U1034, Cardiovascular Adaptation to Ischemia, University of Bordeaux, Pessac, France.
Alexandre
A
Ouattara
D058186:Acute Kidney Injury / Q000097:blood / Q000175:diagnosis / Q000378:metabolism* / Q000503:physiopathology* / Q000652:urine; D000368:Aged; D015415:Biomarkers / Q000032:analysis; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020127:Recovery of Function; D012720:Severity of Illness Index
D015415:Biomarkers
AKI; Doppler ultrasonography; NGAL; [TIMP-2]*[IGFBP7]; biomarkers; neutrophil gelatinase–associated lipocalin