RESUMO
AIM: Fluid balance (FB) is an emerging predictor of acute kidney injury (AKI). We investigated the comparative utility of FB with conventional and novel biomarkers to predict AKI in cardiovascular surgery patients. METHODS: Data collected in a prospective, observational study designed to investigate the relationship between FB and AKI in an academic medical center were utilized for analyses. FB, routine clinical parameters, conventional and novel biomarkers in 100 consecutive cardiovascular surgery patients was analyzed. RESULTS: Each variable studied was divided into quartiles and the lowest quartile served as the referent quartile. The adjusted OR for AKI for the highest vs. lowest quartile of FB was 4.98 (CI95%1.38-24.10, P=0.046), serum creatinine (SCr) 11.54 (CI95% 1.37-97.18, P=0.024), urine NGAL 2.76 (CI95% 0.48-15.93, P=0.255) and IL-18 2.31 (CI95% 0.41-13.16, P=0.346, and serum MCP-1 4.93 (CI95% 0.81-30.09, P=0.084) and TNF-alpha 15.59 (CI95% 1.19-204.19, P=0.036). Comparison of ROC curves demonstrated that the diagnostic performance of FB and SCr to predict AKI were comparable, as were FB with urine NGAL and IL-18 and serum MCP-1 and TNF-alpha.. While there was a graded relationship with the risk for AKI according to quartiles for FB, SCr and serum TNF-alpha, the remaining biomarkers including urine NGAL were not independent predictors of AKI. CONCLUSION: At 24 hours postoperatively, the performance of FB to predict AKI was comparable to that of preoperative conventional and postoperative 24-hour novel biomarkers.
Assuntos
Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/etiologia , Biomarcadores , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Equilíbrio Hidroeletrolítico , Centros Médicos Acadêmicos , Injúria Renal Aguda/sangue , Injúria Renal Aguda/fisiopatologia , Injúria Renal Aguda/urina , Proteínas de Fase Aguda/urina , Idoso , Área Sob a Curva , Biomarcadores/sangue , Biomarcadores/urina , Quimiocina CCL2/sangue , Distribuição de Qui-Quadrado , Creatinina/sangue , Feminino , Florida , Taxa de Filtração Glomerular , Humanos , Interleucina-18/urina , Lipocalina-2 , Lipocalinas/urina , Masculino , Pessoa de Meia-Idade , Razão de Chances , Valor Preditivo dos Testes , Proteínas Proto-Oncogênicas/urina , Curva ROC , Fatores de Risco , Fatores de Tempo , Fator de Necrose Tumoral alfa/sangueRESUMO
Acute kidney injury requiring renal replacement therapy (RRT) is associated with an unacceptably high mortality rate. Despite the identification of the modality, timing and intensity of dialysis, membrane biocompatibility, hollow fiber and catheter properties as potential modifying factors, there is little convincing evidence for the superiority of one over the other. However, the available data suggest that the early initiation of RRT may be beneficial. A focused review of clinical trials and meta-analysis of clinical trials of RRT is provided.
