TY  - JOUR
A1  - Reichetzeder, Christoph
A1  - Heunisch, Fabian
A1  - von Einem, Gina-Franziska
A1  - Tsuprykov, Oleg
A1  - Kellner, Karl-Heinz
A1  - Dschietzig, Thomas
A1  - Kretschmer, Axel
A1  - Hocher, Berthold
T1  - Pre-interventional kynurenine predicts medium-term outcome after contrast media exposure due to coronary angiography
JF  - Kidney & blood pressure research : official organ of the Gesellschaft für Nephrologie ; official organ of the Deutsche Liga zur Bekämpfung des Hohen Blutdruckes e.V., Deutsche Hypertonie-Gesellschaft
N2  - Background/Aims: Contrast induced acute kidney injury (CI-AKI) remains a serious complication of contrast media enhanced procedures like coronary angiography. There is still a lack of established biomarkers that help to identify patients at high risk for short and long-term complications. The aim of the current study was to evaluate plasma kynurenine as a predictive biomarker for CI-AKI and long-term complications, measured by the combined endpoint "major adverse kidney events" (MAKE) up to 120 days after CM application.
Methods: In this prospective cohort study 245 patients undergoing coronary angiography were analyzed. Blood samples were obtained at baseline, 24h and 48h after contrast media (CM) application to diagnose CI-AKI. Patients were followed for 120 days for adverse clinical events including death, the need for dialysis, and a doubling of plasma creatinine. Occurrence of any of these events was summarized in the combined endpoint MAKE.
Results: Preinterventional plasma kynurenine was not associated with CI-AKI. Patients who later developed MAKE displayed significantly increased preinterventional plasma kynurenine levels (p<0.0001). ROC analysis revealed that preinterventional kynurenine is highly predictive for MAKE (AUC=0.838; p<0.0001). The optimal cutoff was found at >= 3.5 mu mol/L. Using this cutoff, the Kaplan-Meier estimator demonstrated that concentrations of plasma kynurenine >= 3.5 mu mol/L were significantly associated with a higher prevalence of MAKE until follow up (p<0.0001). This association remained significant in multivariate Cox regression models adjusted for relevant factors of long-term renal outcome.
Conclusion: Preinterventional plasma kynurenine might serve as a highly predictive biomarker for MAKE up to 120 days after coronary angiography.
KW  - Contrast induced acute kidney injury
KW  - Coronary angiography
KW  - Major adverse kidney event
KW  - Kynurenine
KW  - Preinterventional biomarker
Y1  - 2017
U6  - https://doi.org/10.1159/000477222
SN  - 1420-4096
SN  - 1423-0143
VL  - 42
IS  - 2
SP  - 244
EP  - 256
PB  - Karger
CY  - Basel
ER  -