Kidney Week

Abstract: TH-PO1168

Validation of a Combined Biomarker Including FGF-23, Erythropoietin, and Klotho for Development AKI and Clinical Outcomes in Patients in the Intensive Care Unit (ICU)

Session Information

• Late-Breaking Science Posters
  October 24, 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

• Michea, Luis, Hospital Clinico Universidad de Chile, Santiago, Chile

Luis Michea, MD, PhD

• Toro, Luis, Hospital Clinico Universidad de Chile, Santiago, Chile

Luis Toro, PhD, MD

• Rojas, Veronica, Hospital Clinico Universidad de Chile, Santiago, Chile

Veronica Rojas, RN

• Ponce, Daniela, Hospital Clinico Universidad de Chile, Santiago, Chile

Daniela Ponce, MSc

• Irarrazabal, Carlos, Universidad de los Andes, Santiago, Chile

Carlos Irarrazabal, PhD

• Fischer, Danilo, Universidad de los Andes, Santiago, Chile

Danilo Fischer, MD

• Romero, Carlos, Hospital Clinico Universidad de Chile, Santiago, Chile

Carlos Romero, MD

• Guerrero, Julia, Clinica Alemana de Santiago, Santiago, Chile

Julia Guerrero, PhD, MD

Background

Acute kidney injury (AKI) is a common complication in patients in critical care units (CCUs) associated with increased morbidity and mortality. The development of AKI is associated with increased plasma levels of Fibroblast Growth Factor 23 and Erythropoietin, with a reduction in Klotho. Previously, our group evaluated a combined biomarker using these molecules (named FEK) in a single-center clinical study, observing that critically ill patients with high levels of the FEK biomarker had a higher rate of AKI and worse clinical outcomes. Our objective was to evaluate in a multicenter study whether this combined biomarker predicts the development of AKI and clinical outcomes in critically ill patients.

Methods

Prospective multicenter cohort of 3 critical care units in Chile. Adult patients admitted to the Critical Care Unit with serum creatinine levels in normal ranges were recruited between 2019 and 2022. The diagnostic accuracy of the FEK biomarker in predicting AKI during the first 48 hours after admission was determined by ROC analysis. Secondary outcomes were life support therapy requirements and mortality in the first 28 days of hospitalization. The combined biomarker was compared against serum creatinine, NGAL, and TIMP-2*IGFBP7.

Results

280 patients were recruited, age: 61.3 ± 15.7 years, female: 47%, serum creatinine at admission: 0.71 ± 0.16 mg/dL. During follow-up, 50% developed AKI, 27% required vasoactive drugs, 11% required emergency dialysis, and 10% died. When evaluating the diagnostic capacity of AKI, it was observed that plasma levels of the combined FEK biomarker were significantly higher in patients who developed AKI compared to those who did not. The area under the curve to predict AKI was 0.83 [0.78-0.88]. Finally, patients with high levels of the FEK biomarker had a higher rate of life support therapy requirements and mortality at 28 days of hospitalization (OR: 4.3 [1.6-13.5]).

Conclusion

Our results show that the combined biomarker FEK has a high diagnostic capacity for the development of AKI in critically ill patients and is associated with worse short-term clinical outcomes. Our results suggest that this combined biomarker could be helpful for decision-making in patients admitted to critical care units.

Funding

• Government Support - Non-U.S.