Proenkephalin for the early detection of acute kidney injury in hospitalized patients with chronic kidney disease. (6th August 2018)

• Record Type: Journal Article
• Authors: Breidthardt, Tobias; Jaeger, Cedric; Christ, Andreas; Klima, Theresia; Mosimann, Tamina; Twerenbold, Raphael; Boeddinghaus, Jasper; Nestelberger, Thomas; Badertscher, Patrick; Struck, Joachim; Bergmann, Andreas; Hartmann, Oliver; Kalbermatter, Stefan; Marenzi, Giancarlo; Mueller, Christian
• Is Part Of: European journal of clinical investigation. Volume 48:Number 10(2018)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2018-08-06
• Subjects: acute kidney injury -- chronic kidney disease -- early detection -- proenkephalin -- sensitivity -- specificity; Pathology -- Periodicals; Medical research -- Periodicals; 616.075
• DOI: 10.1111/eci.12999
• Languages: English
• ISSNs: 0014-2972

Abstract

Abstract: Background: The early detection of acute kidney injury (AKI) in patients with chronic kidney disease (CKD) is an unmet clinical need. Proenkephalin (PENK) might improve the early detection of AKI. Methods: One hundred and eleven hospitalized CKD patients undergoing radiographic contrast procedures were enrolled. PENK was measured in a blinded fashion at baseline (before contrast media administration) and on day 1 (after contrast media administration). The potential of PENK levels to predict contrast‐induced AKI was the primary endpoint. Results: Baseline creatinine and baseline PENK were similar in AKI and no‐AKI patients. In AKI patients, day 1 PENK (198 pmol/L vs 121 pmol/L, P < 0.01) was significantly higher compared to no‐AKI patients. The area under the curve (AUC) for the prediction of AKI by day 1 PENK was 0.79, 95% CI: 0.70‐0.87, similar to serum creatinine: 0.78, 95% CI: 0.61‐0.95. Delta PENK was significantly higher in AKI compared to no‐AKI patients (53 pmol/L vs 1 pmol/L, P < 0.01). The AUC for the prediction of AKI by delta PENK was high (0.92, 95%CI 0.82‐1.00) and remained high for creatinine‐blind AKI (0.94, 95% CI: 0.87‐0.97). Conclusion: Delta PENK levels improve the early detection of contrast‐induced AKI in CKD patients over serial creatinine sampling. Delta PENK accelerates the detection of creatinine‐blind AKI by 24 hours.