Abstract: FR-PO071
CCL14 Predicts Response to Diuretics in Patients With Moderate to Severe AKI
Session Information
- AKI: Epidemiology, Risk Factors, Prevention
November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 101 AKI: Epidemiology‚ Risk Factors‚ and Prevention
Authors
- Demirjian, Sevag, Cleveland Clinic, Cleveland, Ohio, United States
- Chawla, Lakhmir S., Veterans affairs, San Diego, California, United States
- Hoste, Eric, Universiteit Gent, Gent, Belgium
- Kampf, Patrick, Astute Medical Inc, San Diego, California, United States
- Koyner, Jay L., University of Chicago, Chicago, Illinois, United States
- McPherson, Paul, Astute Medical Inc, San Diego, California, United States
- Kellum, John A., University of Pittsburgh, Pittsburgh, Pennsylvania, United States
Background
Non-recovery in patients with moderate to severe acute kidney injury (AKI) is associated with morbidity and mortality. Elevated CCL14 levels predict persistent AKI and might facilitate better patient management. We examined whether there is an interaction between CCL14 and diuretic use on urine output in order to guide subsequent volume management.
Methods
We analyzed data on 497 patients enrolled in 2 prior studies where urine output was documented the day prior, and two days following CCL14 measurement. Diuretic use was defined as any diuretic exposure from one day prior to one day following the CCL14 measurement. Urine output was compared across previously reported three categories of CCL14 (</=1.3, >1.3-13, >13 ng/mL) and by diuretic status using Tukey’s honestly significant difference test.
Results
In the overall cohort 242 (49%) patients received diuretics; 55%, 46% and 34% in patients with low, intermediate and high CCL14 levels, respectively. Urine output over 72 hours was greater with diuretics when CCL14 was low (</= 1.3 ng/mL) (difference in means (95%CI) = 2596 ml (1157 – 4034) ml, p= < .001), but not when CCL14 was elevated (Figure).
Conclusion
Response to diuretics was only observed in patients with low CCL14 (</=1.3 ng/mL) corresponding to low risk for persistent AKI. Identifying patients with AKI who are unlikely to respond to diuretics may guide clinicians at the bedside to choose alternative means for volume management.
| No diuretic use(n=255) | Diuretics Use (n=242) | p value | |
| Male | 150 (59%) | 154 (64%) | 0.311 |
| Age (years) | 64 (55 - 72) | 67 (57 - 75) | 0.038 |
| Chronic kidney disease | 36 (14%) | 40 (17%) | 0.458 |
| Diabetes mellitus | 82 (32%) | 91 (38%) | 0.221 |
| Heart failure | 37 (15%) | 73 (30%) | <0.001 |
| Baseline serum creatinine (mg/dL) | 1.0 (0.7 - 1.2) | 1.0 (0.8 - 1.3) | 0.026 |
| Non-renal APACHE III score at enrollment | 56 (40 - 75) | 55 (44 - 76) | 0.168 |
| Fluid balance1 (mL) on Day 1 | 3234 (1477 - 6328) | 2122 (319 - 4282) | <0.001 |
| CCL14 concentration1 (ng/mL) | 2.17 (0.77 - 7.07) | 1.28 (0.56 - 4.60) | 0.004 |
Funding
- Commercial Support – Astute medical