PMID- 33549487 OWN - NLM STAT- MEDLINE DCOM- 20210520 LR - 20220716 IS - 1532-8422 (Electronic) IS - 1053-0770 (Print) IS - 1053-0770 (Linking) VI - 35 IP - 6 DP - 2021 Jun TI - Intraoperative Urinary Biomarkers and Acute Kidney Injury After Cardiac Surgery. PG - 1691-1700 LID - S1053-0770(20)31373-2 [pii] LID - 10.1053/j.jvca.2020.12.026 [doi] AB - OBJECTIVES: To evaluate the association of intraoperative urinary biomarker excretion during cardiac surgery and the subsequent development of acute kidney injury (AKI). DESIGN: Prospective, nonrandomized, observational study. SETTING: Single tertiary-level, university-affiliated hospital. PARTICIPANTS: Ninety patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Urinary samples were collected every 30 minutes intraoperatively and then at four, 12, and 24 hours after CPB. Samples were measured for interleukin 18 (IL-18), kidney injury molecule-1 (KIM1), and creatinine concentrations. Urinary biomarker excretion (raw and indexed to creatinine) for four intraoperative and three postoperative points were compared between patients with and those without subsequent AKI defined by increased serum creatinine concentration >/=0.3 mg/dL within the first 48 hours or >/=1.5 times baseline within seven days. Raw and indexed median IL-18 values were similar between AKI groups at all intraoperative points, but became significantly different at 12 hours after CPB. Raw and indexed median KIM1 values were significantly different between AKI groups at multiple intraoperative points and at four and 12 hours after CPB. During intraoperative and postoperative points, patients in the fourth quartile of KIM1 excretion had greater AKI incidence and longer intensive care and hospital lengths of stay than those in the first quartile. Only postoperatively did the differences in these outcomes between the fourth and first quartile of IL-18 excretion occur. CONCLUSIONS: Intraoperative KIM1 but not IL-18 excretion was associated with postoperative development of AKI. CI - Copyright (c) 2020 Elsevier Inc. All rights reserved. FAU - Silverton, Natalie A AU - Silverton NA AD - Department of Anesthesiology, University of Utah, Salt Lake City, UT. Electronic address: natalie.silverton@hsc.utah.edu. FAU - Hall, Isaac E AU - Hall IE AD - Department of Internal Medicine, Division of Nephrology and Hypertension, University of Utah, School of Medicine, Salt Lake City, UT. FAU - Melendez, Natalia P AU - Melendez NP AD - Department of Anesthesiology, University of Utah, Salt Lake City, UT. FAU - Harris, Brad AU - Harris B AD - Department of Anesthesiology, University of Utah, School of Medicine, Salt Lake City, UT. FAU - Harley, Jackson S AU - Harley JS AD - Department of Anesthesiology, University of Utah, School of Medicine, Salt Lake City, UT. FAU - Parry, Samuel R AU - Parry SR AD - Department of Statistics, Brigham Young University, Provo, UT. FAU - Lofgren, Lars R AU - Lofgren LR AD - Department of Anesthesiology, University of Utah, School of Medicine, Salt Lake City, UT. FAU - Stoddard, Gregory J AU - Stoddard GJ AD - Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, UT. FAU - Hoareau, Guillaume L AU - Hoareau GL AD - Department of Surgery, Division of Emergency Medicine, University of Utah, Salt Lake City, UT. FAU - Kuck, Kai AU - Kuck K AD - Department of Anesthesiology, University of Utah, School of Medicine, Salt Lake City, UT. LA - eng GR - KL2 TR002539/TR/NCATS NIH HHS/United States GR - UL1 TR002538/TR/NCATS NIH HHS/United States PT - Journal Article PT - Observational Study DEP - 20210204 PL - United States TA - J Cardiothorac Vasc Anesth JT - Journal of cardiothoracic and vascular anesthesia JID - 9110208 RN - 0 (Biomarkers) RN - AYI8EX34EU (Creatinine) SB - IM CIN - J Cardiothorac Vasc Anesth. 2021 Jun;35(6):1701-1703. PMID: 33832804 MH - *Acute Kidney Injury/diagnosis/epidemiology/etiology MH - Biomarkers MH - *Cardiac Surgical Procedures/adverse effects MH - Cardiopulmonary Bypass/adverse effects MH - Creatinine MH - Humans MH - Postoperative Complications/diagnosis/epidemiology/etiology MH - Prospective Studies PMC - PMC8647416 MID - NIHMS1670679 OTO - NOTNLM OT - acute kidney injury OT - cardiac surgery OT - urinary biomarkers COIS- Conflict of Interest N. Silverton, K. Kuck, and L. Lofgren are inventors on a patent application for a urine oxygen and flow sensing technology. This prototype is under development for commercial consideration by N. Silverton and K. Kuck but as of yet no commercial activity has occurred. This technology is unrelated to urinary biomarker monitoring. Nonetheless, this work was performed under a conflict of interest management plan approved by the University of Utah Conflict of Interest Office. This included disclosure of conflict of interest to patients and collaborators and an independent peer review of the data analysis. No other authors have any disclosures to declare. The interpretation and reporting of these data are the responsibility of the authors alone and should not be seen as an official policy of or interpretation by the US government, nor does this report necessarily represent the official views of the National Institutes of Health. EDAT- 2021/02/08 06:00 MHDA- 2021/05/21 06:00 PMCR- 2022/06/01 CRDT- 2021/02/07 20:32 PHST- 2020/11/17 00:00 [received] PHST- 2020/12/08 00:00 [revised] PHST- 2020/12/16 00:00 [accepted] PHST- 2021/02/08 06:00 [pubmed] PHST- 2021/05/21 06:00 [medline] PHST- 2021/02/07 20:32 [entrez] PHST- 2022/06/01 00:00 [pmc-release] AID - S1053-0770(20)31373-2 [pii] AID - 10.1053/j.jvca.2020.12.026 [doi] PST - ppublish SO - J Cardiothorac Vasc Anesth. 2021 Jun;35(6):1691-1700. doi: 10.1053/j.jvca.2020.12.026. Epub 2021 Feb 4.