Kidney Week

Abstract: FR-PO099

Nonalbumin Proteinuria (NAP): An Accessible, Affordable, and Easy-to-Use Biomarker for Predicting AKI in Patients with Acute Heart Failure (NAP-AHF Study)

Session Information

• AKI: Diagnosis and Outcomes
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• Jaturapisanukul, Solos, Navamindradhiraj University, Bangkok, Thailand

Solos Jaturapisanukul, MD

• Jaiprasart, Khageephan, Navamindradhiraj University, Bangkok, Thailand

Khageephan Jaiprasart, MD

• Limbutara, Kavee, Navamindradhiraj University, Bangkok, Thailand

Kavee Limbutara, MD

• Thanapongsatorn, Peerapat, Thammasat University Hospital, Khlong Nueng, Pathum Thani, Thailand

Peerapat Thanapongsatorn

• Laungchuaychok, Punnawit, Navamindradhiraj University, Bangkok, Thailand

Punnawit Laungchuaychok, MD

• Ngamvichchukorn, Tanun, Navamindradhiraj University, Bangkok, Thailand

Tanun Ngamvichchukorn, MD

• Pongsitisak, Wanjak, Navamindradhiraj University, Bangkok, Thailand

Wanjak Pongsitisak, MD

Background

Early identification of AKI in patients with acute heart failure (AHF) is challenging in low- to middle-income countries, due to the high costs and limited access to many biomarkers. This study evaluates the effectiveness of non-albumin proteinuria (NAP), as measured by the difference between the Urine Protein-to-Creatinine Ratio (PCR) and the Urine Albumin-to-Creatinine Ratio (ACR), in predicting AKI among AHF patients.

Methods

This prospective study was conducted in a single center in Thailand, from August 2023 to April 2024. We assessed patients admitted with AHF to determine whether NAP at the time of AHF diagnosis could predict the development of AKI within 7 days. Serum creatinine were monitored at baseline, day 2, day 7, and day 28. Exclusion criteria included a PCR ≥ 3 g/gCr, presence of pyuria or hematuria, CKD stage 5, or AKI stage 2-3 or need of KRT.

Results

144 AHF patients studied, 15.28% developed AKI. The levels of NAP at admission were significantly higher in patients who developed AKI (0.51 vs 0.23, p < 0.001). A NAP value ≥ 0.3 g/gCr was significantly associated with the development of AKI by day 2 (30.2% vs 4.3%, p = 0.022), by day 7 (34% vs 4.4%, p < 0.001), and with acute kidney disease (AKD) by day 28 (15.1% vs 3.3%, p < 0.01). Multivariate analysis identified a NAP value ≥ 0.3 g/gCr as a significant predictor of AKI in AHF patients, with a sensitivity of 81.8% and a specificity of 73.0%. Furthermore, the AUROC for NAP was 0.861, demonstrating better predictive ability than PCR, ACR, or pro-BNP for AKI in AHF patients.

Conclusion

An increase in NAP, indicative of tubular protein damage, correlates with the development of AKI in AHF patients. Thus, NAP presents as a promising tool for predicting AKI in this patient population.

AUROC to evaluate the parameters' predictive capability for AKI in acute heart failure patients