Biomarkers of Renal Injury in Cirrhosis: Association with Acute Kidney Injury and Recovery after Liver Transplantation

Ashwani K. Singal, Bradford Jackson, Glauber B. Pereira, Kirk B. Russ, Paul Stephen Fitzmorris, Donny Kakati, Page Axley, Sujan Ravi, Toni Seay, Satish P. Ramachandra Rao, Ravindra Mehta, Yong Fang Kuo, Karan P. Singh, Anupam Agarwal

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: To define urine or serum biomarkers in predicting renal function recovery after liver transplantation (LT). Methods: Adults listed for LT (February 2011-July 2014) and with modified diet for renal disease-6 (MDRD-6) <60 mL/min provided urine/blood samples at baseline and serially until LT for biomarkers in serum (pg/mL) and urine (pg/mg creatinine). Results: Of 271 LT listed patients (mean age 57 years, 63% males, median listing MELD 17.5), 1 year acute kidney injury (AKI) probability was 49%, with odds of 1.3-, 3.0-, 4.6-, and 8.5-fold times for listing MELD 16-20, 21-25, 26-30, and >30, compared to MELD <16. Thirty-seven people died over 1 year from the time of listing, with twofold increased odds with AKI. Among 67 patients with MDRD <60, only urinary epidermal growth factor was different comparing AKI (increase in serum creatinine ≥0.3 mg/dL from baseline within past 3 months) vs. no AKI (2,254 vs. 4,253, p = 0.003). Differences between acute tubular necrosis (ATN) and hepatorenal syndrome could not be ascertained for a small sample of 3 patients with ATN. Analyzing 15 of 43 receiving LT and MDRD-6 <30 prior to LT, biomarkers were not different comparing 5 patients recovering renal function (MDRD-6 >50 mL/min) at 6 months vs. 10 without recovery. Conclusions: AKI is common among LT listed patients, with a negative impact on transplant-free survival. Serum and urine biomarkers are not associated with the recovery of renal function after LT. Multicenter studies are suggested to (a) develop strategies to reduce the development of AKI and (b) derive novel biomarkers for use in accurately predicting renal recovery after LT.

Original languageEnglish (US)
JournalNephron
DOIs
StateAccepted/In press - Sep 2 2017

Fingerprint

Acute Kidney Injury
Liver Transplantation
Fibrosis
Biomarkers
Kidney
Wounds and Injuries
Recovery of Function
Urine
Serum
Multicenter Studies
Diet
Transplants
Survival

Keywords

  • Acute kidney injury
  • Biomarkers
  • Cirrhosis
  • End-stage renal disease
  • Simultaneous liver kidney

ASJC Scopus subject areas

  • Physiology
  • Nephrology
  • Urology
  • Physiology (medical)

Cite this

Singal, A. K., Jackson, B., Pereira, G. B., Russ, K. B., Fitzmorris, P. S., Kakati, D., ... Agarwal, A. (Accepted/In press). Biomarkers of Renal Injury in Cirrhosis: Association with Acute Kidney Injury and Recovery after Liver Transplantation. Nephron. https://doi.org/10.1159/000479074

Biomarkers of Renal Injury in Cirrhosis : Association with Acute Kidney Injury and Recovery after Liver Transplantation. / Singal, Ashwani K.; Jackson, Bradford; Pereira, Glauber B.; Russ, Kirk B.; Fitzmorris, Paul Stephen; Kakati, Donny; Axley, Page; Ravi, Sujan; Seay, Toni; Ramachandra Rao, Satish P.; Mehta, Ravindra; Kuo, Yong Fang; Singh, Karan P.; Agarwal, Anupam.

In: Nephron, 02.09.2017.

Research output: Contribution to journalArticle

Singal, AK, Jackson, B, Pereira, GB, Russ, KB, Fitzmorris, PS, Kakati, D, Axley, P, Ravi, S, Seay, T, Ramachandra Rao, SP, Mehta, R, Kuo, YF, Singh, KP & Agarwal, A 2017, 'Biomarkers of Renal Injury in Cirrhosis: Association with Acute Kidney Injury and Recovery after Liver Transplantation', Nephron. https://doi.org/10.1159/000479074
Singal, Ashwani K. ; Jackson, Bradford ; Pereira, Glauber B. ; Russ, Kirk B. ; Fitzmorris, Paul Stephen ; Kakati, Donny ; Axley, Page ; Ravi, Sujan ; Seay, Toni ; Ramachandra Rao, Satish P. ; Mehta, Ravindra ; Kuo, Yong Fang ; Singh, Karan P. ; Agarwal, Anupam. / Biomarkers of Renal Injury in Cirrhosis : Association with Acute Kidney Injury and Recovery after Liver Transplantation. In: Nephron. 2017.
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abstract = "Background: To define urine or serum biomarkers in predicting renal function recovery after liver transplantation (LT). Methods: Adults listed for LT (February 2011-July 2014) and with modified diet for renal disease-6 (MDRD-6) <60 mL/min provided urine/blood samples at baseline and serially until LT for biomarkers in serum (pg/mL) and urine (pg/mg creatinine). Results: Of 271 LT listed patients (mean age 57 years, 63{\%} males, median listing MELD 17.5), 1 year acute kidney injury (AKI) probability was 49{\%}, with odds of 1.3-, 3.0-, 4.6-, and 8.5-fold times for listing MELD 16-20, 21-25, 26-30, and >30, compared to MELD <16. Thirty-seven people died over 1 year from the time of listing, with twofold increased odds with AKI. Among 67 patients with MDRD <60, only urinary epidermal growth factor was different comparing AKI (increase in serum creatinine ≥0.3 mg/dL from baseline within past 3 months) vs. no AKI (2,254 vs. 4,253, p = 0.003). Differences between acute tubular necrosis (ATN) and hepatorenal syndrome could not be ascertained for a small sample of 3 patients with ATN. Analyzing 15 of 43 receiving LT and MDRD-6 <30 prior to LT, biomarkers were not different comparing 5 patients recovering renal function (MDRD-6 >50 mL/min) at 6 months vs. 10 without recovery. Conclusions: AKI is common among LT listed patients, with a negative impact on transplant-free survival. Serum and urine biomarkers are not associated with the recovery of renal function after LT. Multicenter studies are suggested to (a) develop strategies to reduce the development of AKI and (b) derive novel biomarkers for use in accurately predicting renal recovery after LT.",
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AU - Jackson, Bradford

AU - Pereira, Glauber B.

AU - Russ, Kirk B.

AU - Fitzmorris, Paul Stephen

AU - Kakati, Donny

AU - Axley, Page

AU - Ravi, Sujan

AU - Seay, Toni

AU - Ramachandra Rao, Satish P.

AU - Mehta, Ravindra

AU - Kuo, Yong Fang

AU - Singh, Karan P.

AU - Agarwal, Anupam

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N2 - Background: To define urine or serum biomarkers in predicting renal function recovery after liver transplantation (LT). Methods: Adults listed for LT (February 2011-July 2014) and with modified diet for renal disease-6 (MDRD-6) <60 mL/min provided urine/blood samples at baseline and serially until LT for biomarkers in serum (pg/mL) and urine (pg/mg creatinine). Results: Of 271 LT listed patients (mean age 57 years, 63% males, median listing MELD 17.5), 1 year acute kidney injury (AKI) probability was 49%, with odds of 1.3-, 3.0-, 4.6-, and 8.5-fold times for listing MELD 16-20, 21-25, 26-30, and >30, compared to MELD <16. Thirty-seven people died over 1 year from the time of listing, with twofold increased odds with AKI. Among 67 patients with MDRD <60, only urinary epidermal growth factor was different comparing AKI (increase in serum creatinine ≥0.3 mg/dL from baseline within past 3 months) vs. no AKI (2,254 vs. 4,253, p = 0.003). Differences between acute tubular necrosis (ATN) and hepatorenal syndrome could not be ascertained for a small sample of 3 patients with ATN. Analyzing 15 of 43 receiving LT and MDRD-6 <30 prior to LT, biomarkers were not different comparing 5 patients recovering renal function (MDRD-6 >50 mL/min) at 6 months vs. 10 without recovery. Conclusions: AKI is common among LT listed patients, with a negative impact on transplant-free survival. Serum and urine biomarkers are not associated with the recovery of renal function after LT. Multicenter studies are suggested to (a) develop strategies to reduce the development of AKI and (b) derive novel biomarkers for use in accurately predicting renal recovery after LT.

AB - Background: To define urine or serum biomarkers in predicting renal function recovery after liver transplantation (LT). Methods: Adults listed for LT (February 2011-July 2014) and with modified diet for renal disease-6 (MDRD-6) <60 mL/min provided urine/blood samples at baseline and serially until LT for biomarkers in serum (pg/mL) and urine (pg/mg creatinine). Results: Of 271 LT listed patients (mean age 57 years, 63% males, median listing MELD 17.5), 1 year acute kidney injury (AKI) probability was 49%, with odds of 1.3-, 3.0-, 4.6-, and 8.5-fold times for listing MELD 16-20, 21-25, 26-30, and >30, compared to MELD <16. Thirty-seven people died over 1 year from the time of listing, with twofold increased odds with AKI. Among 67 patients with MDRD <60, only urinary epidermal growth factor was different comparing AKI (increase in serum creatinine ≥0.3 mg/dL from baseline within past 3 months) vs. no AKI (2,254 vs. 4,253, p = 0.003). Differences between acute tubular necrosis (ATN) and hepatorenal syndrome could not be ascertained for a small sample of 3 patients with ATN. Analyzing 15 of 43 receiving LT and MDRD-6 <30 prior to LT, biomarkers were not different comparing 5 patients recovering renal function (MDRD-6 >50 mL/min) at 6 months vs. 10 without recovery. Conclusions: AKI is common among LT listed patients, with a negative impact on transplant-free survival. Serum and urine biomarkers are not associated with the recovery of renal function after LT. Multicenter studies are suggested to (a) develop strategies to reduce the development of AKI and (b) derive novel biomarkers for use in accurately predicting renal recovery after LT.

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KW - Biomarkers

KW - Cirrhosis

KW - End-stage renal disease

KW - Simultaneous liver kidney

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