Post-operative serum uric acid and acute kidney injury

    Authors

    A. A. Ejaz; G. Kambhampati; N. I. Ejaz; B. Dass; V. Lapsia; A. A. Arif; A. Asmar; M. Shimada; M. M. Alsabbagh; R. Aiyer;R. J. Johnson

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    Abbreviated Journal Title

    J. Nephrol.

    Keywords

    Acute kidney injury; Post-operative; Uric acid; ACUTE-RENAL-FAILURE; GELATINASE-ASSOCIATED LIPOCALIN; ADULT; CARDIAC-SURGERY; NECROSIS-FACTOR-ALPHA; HIGH-RISK; PREDICT; HYPERURICEMIA; RASBURICASE; SEVERITY; LYMPHOMA; Urology & Nephrology

    Abstract

    Background: We hypothesized that post-operative serum uric acid (SUA) may be associated with acute kidney injury (AKI). Methods: In this prospective, observational study, the relationships between SUA, urine neutrophil gelatinase-associated lipocalin (uNGAL) and interleukin-18 (uIL-18), serum monocyte chemoattractant protein-1 (sMCP-1) and tumor necrosis factor-alpha (sTNF-alpha), and incidence of AKI were determined. SUA were divided into tertiles and their association with AKI investigated. Results: A total of 100 cardiac surgery patients were included for analyses. The 1st, 2nd, and 3rd SUA tertiles were associated with 15.1%, 11.7%, and 54.5% incidence of AKI, respectively. The 3rd SUA tertile, compared to the referent 1st tertile, was associated with an eightfold (OR 8.38, CI95% 2.13-33.05, p=0.002) increased risk for AKI. Patients with AKI on post-operative day 1 (n=11) were then excluded for the purpose of determining the predictive value of SUA to diagnose AKI on postoperative day 2 and during hospital stay. In comparison to the referent 1st tertile, the 3rd tertile SUA was associated with an eightfold increased risk for AKI on post-operative day 2 (adjusted OR 7.94, CI95% 1.50-42.08, P=.015) and a five-fold increased risk for AKI during hospital stay (OR 4.83, CI95% 1.21-19.20, P=.025), respectively. SUA (Area Under Curve, AUC 0.77 (CI95% 0.66-0.88, P < .001), serum creatinine (0.73, CI95%, 0.62-0.84, P < .001) and sTNF-alpha (0.76, CI95% 0.65-0.87, P < .001) had the best diagnostic performance measured by the Receiver Operating Characteristics curves. Conclusions: We conclude that post-operative SUA is associated with an increased risk for AKI and compares well to conventional markers of AKI.

    Journal Title

    Journal of Nephrology

    Volume

    25

    Issue/Number

    4

    Publication Date

    1-1-2013

    Document Type

    Article

    Language

    English

    First Page

    497

    Last Page

    505

    WOS Identifier

    WOS:000308620700007

    ISSN

    1121-8428

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