Abstract: FR-PO138
Plasma Cystatin C Predicts Kidney Function Recovery in Patients Requiring Continuous Kidney Replacement Therapy (CKRT) for AKI
Session Information
- AKI: Outcomes, RRT
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Haeger, Sarah, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Okamura, Kayo, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- He, Zhibin, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Li, Amy Shijia, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Colbert, James F., University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Campbell, Ruth E., University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Griffin, Benjamin R., University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
- Faubel, Sarah, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
Background
AKI requiring KRT is a common complication in hospitalized patients that confers increased mortality. Tools to predict timing of kidney function recovery and mortality are needed. Cystatin C (CysC) is a marker of kidney function that may reflect residual kidney function while on KRT. Herein, we tested the hypothesis that lower plasma cysC concentrations would predict early kidney function recovery in patients with AKI requiring CKRT.
Methods
51 patients without chronic kidney disease requiring CKRT for AKI were studied. Plasma was collected prior to CKRT initiation, and plasma and effluent were collected on days 1, 2, and 3 of CKRT. Two groups were studied: early kidney function recovery (EKFR, liberated from dialysis within 7 days of CKRT initiation, N = 15) and delayed kidney function recovery or death (DKFR/D, on dialysis 21 days after CKRT initiation or death prior to renal recovery, N = 36). CysC, creatinine, and blood urea nitrogen (BUN) were measured in plasma and effluent, and CKRT dose and urine output were recorded.
Results
Mean plasma cysC (mg/L) was significantly lower on days 1 (1.79 vs 2.41, p = 0.03) and 2 (1.91 vs 2.41, p = 0.03) of CKRT in patients with EKFR versus DKFR/D. There was no difference in serum creatinine or BUN between the two groups. CysC on days 1 and 2 of CKRT predicted early kidney function recovery (day 1 ROC AUC 0.765, p = 0.003; day 2 ROC AUC 0.751, p = 0.010). CKRT clearance of cysC and cysC sieving coefficient were similar between the two groups. The average cysC sieving coefficient in all patients was 0.59, 0.61, and 0.61 on days 1, 2, and 3 of CKRT respectively.
Conclusion
CysC on days 1 and 2 of CKRT predicts early kidney function recovery. The lower concentration of plasma cysC in patients with EKFR was not due to differences in CKRT cysC clearance. Since cysC is moderately cleared by CKRT, it is only predictive at early timepoints after CKRT initiation. CysC is available in clinical practice, thus measuring cysC in patients on CKRT for AKI is feasible and would fill a void in data that is needed to support discussions between clinical providers and patients regarding outcomes and prognosis.
Funding
- Commercial Support – Baxter Investigator Initiative Grant