Prediction of contrast‐induced acute kidney injury by early post‐procedural analysis of urinary biomarkers and intra‐renal Doppler flow indices in patients undergoing coronary angiography |
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| Authors: | Maciej T. Wybraniec MD PhD Jerzy Chudek MD PhD Maria Bożentowicz‐Wikarek MSc PhD Katarzyna Mizia‐Stec MD PhD |
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| Affiliation: | 1. First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Public Hospital No. 7 in Katowice ? Upper Silesia Medical Centre, Katowice, Poland;2. Department of Pathophysiology, Medical University of Silesia, Katowice, Poland |
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| Abstract: | Background The study was designed to evaluate the applicability of combined assessment of urinary biomarkers and intra‐renal Doppler flow indices for the prediction of contrast‐induced acute kidney injury (CI‐AKI) after coronary angiography/percutaneous coronary interventions (CA/PCI). Methods This prospective observational study covered 95 consecutive patients with coronary artery disease subject to elective or urgent CA/PCI. Doppler intra‐renal flow indices were assessed before and 1 h following CA/PCI. Urine samples were collected within 24 h before and 6 h after CA/PCI and assayed for urinary interleukin‐18 (IL‐18), liver‐fatty acid‐binding protein (L‐FABP), and kidney injury molecule‐1 (KIM‐1) using ELISA method. CI‐AKI was defined as ≥50% relative or ≥0.3 mg/dL absolute increase of serum creatinine concentration at 48 h post‐procedurally. Results CI‐AKI was confirmed in nine patients (9.5%). CI‐AKI onset was associated with significantly higher urinary KIM‐1 at 6 h (P = 0.003) and ΔKIM‐1 concentrations (P = 0.001), and urinary IL‐18 at 6 h (P = 0.014) and ΔIL‐18 concentrations (P = 0.012), however, L‐FABP and ΔL‐FABP levels were comparable in both groups. Receiver operating characteristic curve analysis denoted that post‐procedural IL‐18 levels at 6 h >89.8 pg/mg (AUC = 0.75, P = 0.007), KIM‐1 at 6 h >0.425 ng/mg (AUC = 0.81, P = 0.001), renal resistive index (RRI) at 1 h >0.73 (AUC 0.88; P < 0.0001), and renal pulsatility index (RPI) at 1 h >0.86 (AUC = 0.86; P < 0.0001) predicted CI‐AKI onset. Logistic regression analysis of postoperative predictors revealed that IL‐18 and RRI were independent predictors of CI‐AKI onset (AUC = 0.96; P < 0.0001). Conclusions Joint assessment of early post‐procedural urinary biomarkers and Doppler renovascular parameters aids early diagnosis of CI‐AKI in patients undergoing coronary interventions. |
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| Keywords: | contrast‐induced acute kidney injury IL‐18 KIM‐1 L‐FABP renal resistive index RRI |
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