Menez Steven, Hanouneh Mohamad, Shafi Tariq, Jaar Bernard G
Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, 1830 E. Monument Street, Suite 416, Baltimore, MD, 21287, USA.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
BMC Nephrol. 2019 Jul 26;20(1):280. doi: 10.1186/s12882-019-1465-0.
Patients who develop acute kidney injury (AKI) have significantly higher short-term outcomes including in-hospital mortality. The development of AKI has been associated with long-term consequences including progression to chronic kidney disease (CKD) and higher rates of cardiovascular disease (CVD) and mortality. In recent years there has been a growing push for the discovery of novel methods to diagnose AKI at earlier stages, and for an improvement in risk stratification and prognosis following AKI.Wang and colleagues assessed the association of total serum indoxyl sulfate (IS) levels, a protein bound uremic toxin, with 90-day mortality after hospital-acquired AKI (HA-AKI). These authors found that serum IS levels were significantly elevated in patients with HA-AKI (2.74 ± 0.75 μg/mL) compared to healthy subjects (1.73 ± 0.11 μg/ml, P < 0.001) and critically ill patients (2.46 ± 0.35 μg/ml, P = 0.016).The mechanisms of this relationship remain unclear, with a limited understanding of cause-specific mortality associated with either the high or low-IS group. One limitation of this current study is an understanding of the acceptable or expected higher level in IS during episodes of AKI. IS levels remained persistently elevated at day 7 compared to β2-microglobulin and serum creatinine which were both lower at 7 days. It is unclear, however, if levels of β2-microglobulin and serum creatinine were lower for other reasons, such as if any patients with AKI required dialysis.This work provides an important addition to the field of AKI research, specifically in the evaluation of readily measurable biomarkers and outcomes after AKI. Moving forward, further validation in studies of acute kidney injury are needed to develop a better understanding of IS levels at the time of AKI diagnosis and trends during the course of AKI.
发生急性肾损伤（AKI）的患者短期预后显著更差，包括住院死亡率更高。AKI的发生与长期后果相关，包括进展为慢性肾脏病（CKD）、心血管疾病（CVD）发生率更高以及死亡率更高。近年来，人们越来越迫切地希望发现能够在更早阶段诊断AKI的新方法，并改善AKI后的风险分层和预后。王及其同事评估了血清总吲哚硫酸酯（IS）水平（一种蛋白结合尿毒症毒素）与医院获得性AKI（HA-AKI）后90天死亡率之间的关联。这些作者发现，与健康受试者（1.73±0.11μg/ml，P<0.001）和危重症患者（2.46±0.35μg/ml，P=0.016）相比，HA-AKI患者的血清IS水平显著升高（为2.74±0.75μg/ml）。这种关系的机制仍不清楚，对与高IS组或低IS组相关的特定病因死亡率了解有限。当前这项研究的一个局限性在于对AKI发作期间IS可接受或预期的更高水平缺乏认识。与在第7天时均较低的β2微球蛋白和血清肌酐相比，IS水平在第7天时仍持续升高。然而，尚不清楚β2微球蛋白和血清肌酐水平较低是否有其他原因，比如是否有任何AKI患者需要透析。这项工作为AKI研究领域做出了重要补充，特别是在评估易于测量的生物标志物以及AKI后的预后方面。展望未来，需要在急性肾损伤研究中进行进一步验证，以更好地了解AKI诊断时的IS水平以及AKI病程中的变化趋势。
