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Blood HCO3- concentration predicts the long-term prognosis of acute kidney injury patients
Aim: To evaluate the value of HCO3- concentrations in long-term prognosis after acute kidney injury. Patients & methods: A total of 169 AKI patients were included in this study. At the 12‐month follow-up, the patients were divided into recovered and unrecovered groups. Results: The blood HCO3- concentrations were significantly correlated with poor prognosis. The area under the curve for renal prognosis of 6 months later blood HCO3- concentrations was 0.798. Combined HCO3- and Scr level area under the curve was 0.952. Conclusion: The blood HCO3- level was useful in evaluating renal prognosis of acute kidney injury patients. The combination of blood HCO3- concentration and Scr level increased the accuracy of prediction. Keywords: acute kidney injury (AKI) • blood HCO3- concentration • combined markers • Cox regression analysis • follow-up • Kaplan–Meier method • prevention • receiver operating characteristic–area under the curve • renal prognosis
The morbidity and mortality rates of acute kidney injury (AKI) have been increasing [1] in developing and developed countries. AKI can significantly increase in-patient mortality. In recent years, research has increasingly been focused on the early diagnosis and prevention of hospitalized AKI patients; however, the mortality rate of AKI inpatients is still high [2] . Clinical studies have reported that 10 years after being discharged, 24.0– 61.6% of AKI patients develop stages 3–5 of chronic kidney disease (CKD). The risk of end-stage renal disease (ESRD) in elderly AKI patients is 13-fold higher than the overall risk of ESRD for patients with CKD [3,4] . A meta-analysis of 48 studies (a total of 7017 patients) performed by Coca et al. at Yale University revealed that for every 100 patients diagnosed with AKI, 7.8 developed CKD, while 4.9 of every 100 patients developed ESRD [5] . Recently, a number of studies have focused on novel AKI diagnostic biomarkers, including β2-microglobulin, α1 microglobulin, cystatin C, neutrophil gelatinase-related lipid carry proteins, retinol-binding proteins, IL-18 and renal injury
10.2217/BMM.14.91 © 2014 Future Medicine Ltd
Xiajing Che1,‡, Yuanyuan Xie1,‡, Chunlin Wang1, Qin Wang1, Minfang Zhang1, Chaojun Qi1, Zhaohui Ni1 & Shan Mou*,1 Department of Nephrology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, PR China *Author for correspondence: Tel.: +86 21 6838 3121 Fax: +86 21 6838 3124 [email protected] ‡ Authors contributed equally 1
factor-1. These biomarkers are useful in the early diagnosis and long-term prognostic evaluation of AKI. However, the detection of these indices is not universally used in the clinic, and some factors, such as short half-lives, difficult detection and high costs, have restricted their clinical applications [6,7] . Therefore, we aimed to use conventional, clinical, biochemical indices to assess the severity and to evaluate the outcome of AKI patient kidneys. The long-term prognosis [8] of renal function has previously been assessed by inflammation and nutriture (e.g., C-reactive protein/prealbumin). The nutriture and stability of the internal environment are necessary preconditions for maintaining normal vital signs for each important organ in the body. The kidney is one of the most important organs regulating homeostasis, which may delay the progress of renal disease by maintaining the patient’s internal acid-base balance, thereby improving long-term renal function. We detected the HCO3- levels at the onset of AKI and at 3-, 6- and 12‐month follow-ups and examined the value of using
Biomark. Med. (2014) 8(10), 1219–1226
part of
ISSN 1752-0363
1219
Research Article Che, Xie, Wang et al.
Table 1. Comparison of the general condition and the laboratory test results at the onset of acute kidney injury between the renal recovered group and the unrecovered group. Total subjects (n = 169)
Recovered group (n = 118)
Unrecovered group (n = 51) p-value
Male/female
106/63
76/42
30/21
NS
Mean age (years)
50.10 ± 19.30
46.90 ± 18.74
57.35 ± 18.88
Blood HCO3- concentration predicts the long-term prognosis of acute kidney injury patients
Aim: To evaluate the value of HCO3- concentrations in long-term prognosis after acute kidney injury. Patients & methods: A total of 169 AKI patients were included in this study. At the 12‐month follow-up, the patients were divided into recovered and unrecovered groups. Results: The blood HCO3- concentrations were significantly correlated with poor prognosis. The area under the curve for renal prognosis of 6 months later blood HCO3- concentrations was 0.798. Combined HCO3- and Scr level area under the curve was 0.952. Conclusion: The blood HCO3- level was useful in evaluating renal prognosis of acute kidney injury patients. The combination of blood HCO3- concentration and Scr level increased the accuracy of prediction. Keywords: acute kidney injury (AKI) • blood HCO3- concentration • combined markers • Cox regression analysis • follow-up • Kaplan–Meier method • prevention • receiver operating characteristic–area under the curve • renal prognosis
The morbidity and mortality rates of acute kidney injury (AKI) have been increasing [1] in developing and developed countries. AKI can significantly increase in-patient mortality. In recent years, research has increasingly been focused on the early diagnosis and prevention of hospitalized AKI patients; however, the mortality rate of AKI inpatients is still high [2] . Clinical studies have reported that 10 years after being discharged, 24.0– 61.6% of AKI patients develop stages 3–5 of chronic kidney disease (CKD). The risk of end-stage renal disease (ESRD) in elderly AKI patients is 13-fold higher than the overall risk of ESRD for patients with CKD [3,4] . A meta-analysis of 48 studies (a total of 7017 patients) performed by Coca et al. at Yale University revealed that for every 100 patients diagnosed with AKI, 7.8 developed CKD, while 4.9 of every 100 patients developed ESRD [5] . Recently, a number of studies have focused on novel AKI diagnostic biomarkers, including β2-microglobulin, α1 microglobulin, cystatin C, neutrophil gelatinase-related lipid carry proteins, retinol-binding proteins, IL-18 and renal injury
10.2217/BMM.14.91 © 2014 Future Medicine Ltd
Xiajing Che1,‡, Yuanyuan Xie1,‡, Chunlin Wang1, Qin Wang1, Minfang Zhang1, Chaojun Qi1, Zhaohui Ni1 & Shan Mou*,1 Department of Nephrology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, PR China *Author for correspondence: Tel.: +86 21 6838 3121 Fax: +86 21 6838 3124 [email protected] ‡ Authors contributed equally 1
factor-1. These biomarkers are useful in the early diagnosis and long-term prognostic evaluation of AKI. However, the detection of these indices is not universally used in the clinic, and some factors, such as short half-lives, difficult detection and high costs, have restricted their clinical applications [6,7] . Therefore, we aimed to use conventional, clinical, biochemical indices to assess the severity and to evaluate the outcome of AKI patient kidneys. The long-term prognosis [8] of renal function has previously been assessed by inflammation and nutriture (e.g., C-reactive protein/prealbumin). The nutriture and stability of the internal environment are necessary preconditions for maintaining normal vital signs for each important organ in the body. The kidney is one of the most important organs regulating homeostasis, which may delay the progress of renal disease by maintaining the patient’s internal acid-base balance, thereby improving long-term renal function. We detected the HCO3- levels at the onset of AKI and at 3-, 6- and 12‐month follow-ups and examined the value of using
Biomark. Med. (2014) 8(10), 1219–1226
part of
ISSN 1752-0363
1219
Research Article Che, Xie, Wang et al.
Table 1. Comparison of the general condition and the laboratory test results at the onset of acute kidney injury between the renal recovered group and the unrecovered group. Total subjects (n = 169)
Recovered group (n = 118)
Unrecovered group (n = 51) p-value
Male/female
106/63
76/42
30/21
NS
Mean age (years)
50.10 ± 19.30
46.90 ± 18.74
57.35 ± 18.88
