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Original ArticlesAcute Kidney Injury and ICU Nephrology
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Postangiography Increases in Serum Creatinine and Biomarkers of Injury and Repair

Caroline Liu, Maria K. Mor, Paul M. Palevsky, James S. Kaufman, Heather Thiessen Philbrook, Steven D. Weisbord and Chirag R. Parikh
CJASN September 2020, 15 (9) 1240-1250; DOI: https://doi.org/10.2215/CJN.15931219
Caroline Liu
1Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Maria K. Mor
2Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
3Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
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Paul M. Palevsky
4Renal Section, Medical Service, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
5University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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James S. Kaufman
6Division of Nephrology, Veterans Affairs New York Harbor Healthcare System and New York University School of Medicine, New York, New York
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Heather Thiessen Philbrook
1Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Steven D. Weisbord
4Renal Section, Medical Service, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
7Renal Section, Medical Service and Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
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Chirag R. Parikh
1Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Abstract

Background and objectives It is unknown whether iodinated contrast causes kidney parenchymal damage. Biomarkers that are more specific to nephron injury than serum creatinine may provide insight into whether contrast-associated AKI reflects tubular damage. We assessed the association between biomarker changes after contrast angiography with contrast-associated AKI and 90-day major adverse kidney events and death.

Design, setting, participants, & measurements We conducted a longitudinal analysis of participants from the biomarker substudy of the Prevention of Serious Adverse Events following Angiography trial. We measured injury (kidney injury molecule-1, neutrophil gelatinase-associated lipocalin, IL-18) and repair (monocyte chemoattractant protein-1, uromodulin, YKL-40) proteins from plasma and urine samples at baseline and 2–4 hours postangiography. We assessed the associations between absolute changes and relative ratios of biomarkers with contrast-associated AKI and 90-day major adverse kidney events and death.

Results Participants (n=922) were predominately men (97%) with diabetes (82%). Mean age was 70±8 years, and eGFR was 48±13 ml/min per 1.73 m2; 73 (8%) and 60 (7%) participants experienced contrast-associated AKI and 90-day major adverse kidney events and death, respectively. No postangiography urine biomarkers were associated with contrast-associated AKI. Postangiography plasma kidney injury molecule-1 and IL-18 were significantly higher in participants with contrast-associated AKI compared with those who did not develop contrast-associated AKI: 428 (248, 745) versus 306 (179, 567) mg/dl; P=0.04 and 325 (247, 422) versus 280 (212, 366) mg/dl; P=0.009, respectively. The majority of patients did not experience an increase in urine or plasma biomarkers. Absolute changes in plasma IL-18 were comparable in participants with contrast-associated AKI (−30 [−71, −9] mg/dl) and those without contrast-associated AKI (−27 [−53, −10] mg/dl; P=0.62). Relative ratios of plasma IL-18 were also comparable in participants with contrast-associated AKI (0.91; 0.86, 0.97) and those without contrast-associated AKI (0.91; 0.85, 0.96; P=0.54).

Conclusions The lack of significant differences in the absolute changes and relative ratios of injury and repair biomarkers by contrast-associated AKI status suggests that the majority of mild contrast-associated AKI cases may be driven by hemodynamic changes at the kidney.

  • contrast media
  • prognostic biomarker
  • tubular injury
  • urinary biomarkers
  • plasma biomarkers
  • clinical trial
  • renal hemodynamics
  • intrinsic injury
  • creatinine
  • Biomarkers
  • Angiography
  • Received December 26, 2019.
  • Accepted July 2, 2020.
  • Copyright © 2020 by the American Society of Nephrology
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Clinical Journal of the American Society of Nephrology: 15 (9)
Clinical Journal of the American Society of Nephrology
Vol. 15, Issue 9
September 07, 2020
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Postangiography Increases in Serum Creatinine and Biomarkers of Injury and Repair
Caroline Liu, Maria K. Mor, Paul M. Palevsky, James S. Kaufman, Heather Thiessen Philbrook, Steven D. Weisbord, Chirag R. Parikh
CJASN Sep 2020, 15 (9) 1240-1250; DOI: 10.2215/CJN.15931219

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Postangiography Increases in Serum Creatinine and Biomarkers of Injury and Repair
Caroline Liu, Maria K. Mor, Paul M. Palevsky, James S. Kaufman, Heather Thiessen Philbrook, Steven D. Weisbord, Chirag R. Parikh
CJASN Sep 2020, 15 (9) 1240-1250; DOI: 10.2215/CJN.15931219
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Keywords

  • contrast media
  • prognostic biomarker
  • tubular injury
  • urinary biomarkers
  • plasma biomarkers
  • clinical trial
  • renal hemodynamics
  • intrinsic injury
  • creatinine
  • Biomarkers
  • Angiography

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