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2022-07-01

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cc by-nc-sa (c) Josa Laorden, Claudia et al, 2022
Si us plau utilitzeu sempre aquest identificador per citar o enllaçar aquest document: https://hdl.handle.net/2445/191813

Elevated urinary Kidney Injury Molecule 1 (KIM-1) at discharge strongly predicts early mortality following an episode of acute decompensated heart failure

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https://doi.org/10.20452/pamw.16284

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INTRODUCTION Hospitalization for acute decompensation of heart failure (ADHF) is a frequent event associated with long-term adverse effects. Prognosis is even worse if acute kidney injury (AKI) occurs during hospitalization.OBJECTIVES The study aimed to determine whether kidney damage biomarkers neutrophil gelatinase--associatedlipocalin (NGAL), kidney injury molecule 1 (KIM-1), and interleukin 18 (IL-18) might predict AKI and have prognostic value in ADHF.PATIENTS AND METHODS Serum NGAL on admission and urine NGAL, KIM-1, and IL-18 on discharge were determined in 187 ADHF patients enrolled in a prospective, observational, unblinded study. AKI was diagnosed using the Kidney Disease: Improving Global Outcomes criteria. Patients were followed for 12 months to record all-cause mortality.RESULTS A total of 22% patients died during the follow-up, with 52.5% dying within 4 months after discharge. Serum NGAL (P <0.001), urine NGAL (P = 0.047), and urinary KIM-1 (P = 0.014) levels were significantly higher in the deceased patients at discharge. After adjustment for estimated glomerular filtration rate (eGFR), only urinary KIM-1 independently predicted mortality at month 4 (hazard ratio [HR], 3.166; 95% CI, 1.203-8.334; P = 0.020) and month 12 (HR, 1.969; 95% CI, 1.123-3.454; P = 0.018) in Cox regression models. In receiver operating characteristic (ROC) analysis urinary KIM-1 (area under the ROC curve [AUC] = 0.830) outperformed other markers of renal function. The Kaplan-Meier sur-vival analysis showed KIM-1 predictive value as additive to that of AKI incidence and admission eGFR. Admission serum NGAL was higher in AKI patients (P <= 0.001) with a modest diagnostic performance (AUC = 0.667), below that of urea (AUC = 0.732), creatinine (AUC = 0.696), or cystatin C (AUC = 0.676).CONCLUSIONS Discharge urinary KIM-1 was a strong and independent predictor of mortality, particularly during the most vulnerable period shortly after hospitalization. Admission serum NGAL was inferior to conventional renal function parameters in predicting AKI during ADHF.

Matèries

Insuficiència renal aguda, Insuficiencia cardíaca

Matèries (anglès)

Acute renal failure, Heart failure

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Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))

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JOSA LAORDEN, Claudia, et al. Elevated urinary Kidney Injury Molecule 1 (KIM-1) at discharge strongly predicts early mortality following an episode of acute decompensated heart failure. Polish Archives of Internal Medicine. 2022. Vol. 132, num. 9. ISSN 1897-9483. [consulted: 20 of May of 2026]. Available at: https://hdl.handle.net/2445/191813

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