Biomarkers in the prediction of contrast media induced nephropathy

  • \(\bf Background\) Subjects with chronic kidney disease are at increased risk for contrast-induced acute kidney injury (CI-AKI). Risk stratification is traditionally based on glomerular filtration rate (GFR) and proteinuria. The present trial examines, whether tubular and inflammatory biomarkers are able to identify subjects at increased risk as well. \(\bf Methods\) We performed a prospective study in 490 patients undergoing coronary angiography. An increase of serum creatinine concentration \(\geq\) 0.3 mg/dl from baseline to day 2–3 was defined as primary endpoint (CI-AKI). Urinary neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), and calprotectin were assessed < 24h before coronary angiography. Prognostic accuracy was assessed by receiver operating characteristics (ROC) calculations. \(\bf Results\) 30 (6.1%) patients suffered from CI-AKI (27 AKIN stage I, 3 AKIN stage II, 0 AKIN stage III). Those subjects who developed CI-AKI had 3.1 fold higher baseline urinary NGAL/creatinine ratios than those without CI-AKI (60.8 [IQR 18.7–93.1] \(\mu\)g/mg vs. 19.9 [IQR 12.3–38.9] \(\mu\)g/mg, p = 0.001). In those subjects without clinically overt CKD (eGFR > 60 ml/min, urinary albumin creatinine ratio <30 mg/g), the NGAL/creatinine ratio was 2.6 higher in CI-AKI vs. no CI-AKI (47.8 [IQR 11.8–75.3] vs. 18.6 [IQR 11.7–36.3] \(\mu\)g/mg). No significant differences were obtained for KIM-1 and calprotectin (p>0.05 each). ROC analyses revealed an area under the curve (AUC) of 0.68 (95% CI 0.60–0.81) for NGAL/creatinine. An NGAL/creatinine ratio < 56.4 \(\mu\)g/mg has a negative predictive value of 96.5%. \(\bf Conclusions\) The present study is the largest investigation on the use of urinary biomarkers for CI-AKI risk stratification so far. It shows that NGAL provides prognostic information beyond the glomerular biomarkers eGFR and proteinuria.

Download full text files

Export metadata

Additional Services

Share in Twitter Search Google Scholar
Metadaten
Author:Felix Sebastian SeibertORCiDGND, Anja Regina HeringhausGND, Nikolaos PagonasGND, Henrik RudolfORCiDGND, Benjamin Johannes RohnGND, Frederic BauerGND, Nina TimmelsfeldGND, Hans‑Joachim TrappeGND, Nina BabelORCiDGND, Timm WesthoffORCiDGND
URN:urn:nbn:de:hbz:294-76859
DOI:https://doi.org/10.1371/journal.pone.0234921
Parent Title (English):PLoS ONE
Subtitle (English):the BITCOIN study
Publisher:Public Library of Science
Place of publication:San Francisco
Document Type:Article
Language:English
Date of Publication (online):2020/11/27
Date of first Publication:2020/07/16
Publishing Institution:Ruhr-Universität Bochum, Universitätsbibliothek
Volume:15
Issue:7, Article e0234921
First Page:e0234921-1
Last Page:e0234921-12
Institutes/Facilities:Marienhospital Herne, Medizinische Klinik I
Marienhospital Herne, Medizinische Klinik II, Kardiologie und Angiologie
Abteilung für Medizinische Informatik, Biometrie und Epidemiologie
open_access (DINI-Set):open_access
Licence (English):License LogoCreative Commons - CC BY 4.0 - Attribution 4.0 International