TY - JOUR
T1 - Longitudinal biomarkers and kidney disease progression after acute kidney injury
AU - the ASSESS-AKI Consortium
AU - Wen, Yumeng
AU - Xu, Leyuan
AU - Melchinger, Isabel
AU - Thiessen-Philbrook, Heather
AU - Moledina, Dennis G.
AU - Coca, Steven G.
AU - Hsu, Chi Yuan
AU - Go, Alan S.
AU - Liu, Kathleen D.
AU - Siew, Edward D.
AU - Alp Ikizler, T.
AU - Chinchilli, Vernon M.
AU - Kaufman, James S.
AU - Kimmel, Paul L.
AU - Himmelfarb, Jonathan
AU - Cantley, Lloyd G.
AU - Parikh, Chirag R.
N1 - Publisher Copyright:
© 2023, Wen et al. This is an open access article published under the terms of the Creative Commons Attribution 4.0 International License.
PY - 2023/5/8
Y1 - 2023/5/8
N2 - BACKGROUND. Longitudinal investigations of murine acute kidney injury (AKI) suggest that injury and inflammation may persist long after the initial insult. However, the evolution of these processes and their prognostic values are unknown in patients with AKI. METHODS. In a prospective cohort of 656 participants hospitalized with AKI, we measured 7 urine and 2 plasma biomarkers of kidney injury, inflammation, and tubular health at multiple time points from the diagnosis to 12 months after AKI. We used linear mixed-effect models to estimate biomarker changes over time, and we used Cox proportional hazard regressions to determine their associations with a composite outcome of chronic kidney disease (CKD) incidence and progression. We compared the gene expression kinetics of biomarkers in murine models of repair and atrophy after ischemic reperfusion injury (IRI). RESULTS. After 4.3 years, 106 and 52 participants developed incident CKD and CKD progression, respectively. Each SD increase in the change of urine KIM-1, MCP-1, and plasma TNFR1 from baseline to 12 months was associated with 2- to 3-fold increased risk for CKD, while the increase in urine uromodulin was associated with 40% reduced risk for CKD. The trajectories of these biological processes were associated with progression to kidney atrophy in mice after IRI. CONCLUSION. Sustained tissue injury and inflammation, and slower restoration of tubular health, are associated with higher risk of kidney disease progression. Further investigation into these ongoing biological processes may help researchers understand and prevent the AKI-to-CKD transition.
AB - BACKGROUND. Longitudinal investigations of murine acute kidney injury (AKI) suggest that injury and inflammation may persist long after the initial insult. However, the evolution of these processes and their prognostic values are unknown in patients with AKI. METHODS. In a prospective cohort of 656 participants hospitalized with AKI, we measured 7 urine and 2 plasma biomarkers of kidney injury, inflammation, and tubular health at multiple time points from the diagnosis to 12 months after AKI. We used linear mixed-effect models to estimate biomarker changes over time, and we used Cox proportional hazard regressions to determine their associations with a composite outcome of chronic kidney disease (CKD) incidence and progression. We compared the gene expression kinetics of biomarkers in murine models of repair and atrophy after ischemic reperfusion injury (IRI). RESULTS. After 4.3 years, 106 and 52 participants developed incident CKD and CKD progression, respectively. Each SD increase in the change of urine KIM-1, MCP-1, and plasma TNFR1 from baseline to 12 months was associated with 2- to 3-fold increased risk for CKD, while the increase in urine uromodulin was associated with 40% reduced risk for CKD. The trajectories of these biological processes were associated with progression to kidney atrophy in mice after IRI. CONCLUSION. Sustained tissue injury and inflammation, and slower restoration of tubular health, are associated with higher risk of kidney disease progression. Further investigation into these ongoing biological processes may help researchers understand and prevent the AKI-to-CKD transition.
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U2 - 10.1172/jci.insight.167731
DO - 10.1172/jci.insight.167731
M3 - Article
C2 - 36951957
AN - SCOPUS:85159554354
SN - 2379-3708
VL - 8
JO - JCI Insight
JF - JCI Insight
IS - 9
M1 - e167731
ER -