急性肾损伤需要持续肾脏替代治疗患者的胱抑素C与肾功能恢复

Cystatin C and Kidney Function Recovery in Patients Requiring Continuous KRT for Acute Kidney Injury.

作者信息

Haeger Sarah M, Okamura Kayo, Li Amy S, He Zhibin, Park Bryan D, Budnick Isadore M, Foulon North, Kennis Matthew, Blaine Rachel E, Miyazaki Makoto, Campbell Ruth, Jalal Diana I, Colbert James F, Brinton John T, Griffin Benjamin R, Faubel Sarah

机构信息

Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.

Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.

出版信息

Clin J Am Soc Nephrol. 2024 Nov 1;19(11):1395-1404. doi: 10.2215/CJN.0000000000000531. Epub 2024 Aug 21.

DOI:10.2215/CJN.0000000000000531

PMID:39167447

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11556902/

Abstract

KEY POINTS

Plasma cystatin C is decreased in participants with AKI requiring continuous KRT (CKRT) with early kidney function recovery. Despite being cleared by CKRT, plasma cystatin C in the first 3 days of CKRT may be a useful clinical tool to help predict the prognosis of AKI requiring CKRT.

BACKGROUND

Plasma cystatin C is a reliable marker to estimate kidney function; however, it is unknown whether this remains true in patients receiving continuous KRT (CKRT). In this study, we tested the hypothesis that lower concentrations of plasma cystatin C during the first 3 days of CKRT would predict kidney function recovery.

METHODS

We performed a retrospective observational study of 72 patients from a 126-patient, single-center CKRT study. We studied two defined cohorts of patients without advanced CKD who had AKI requiring CKRT: () with early kidney function recovery defined as liberation from KRT within 7 days of CKRT initiation versus () with delayed kidney function recovery defined as receipt of KRT for >21 days or death while on KRT. Subsequent analysis included patients with advanced CKD and intermediate kidney function recovery (liberation between 8 and 21 days). Cystatin C was then measured on stored plasma, urine, and dialysis effluent collected before CKRT initiation and on days 1, 2, and 3 of CKRT.

RESULTS

Plasma cystatin C was significantly lower in patients with early kidney function recovery in comparison with patients with delayed kidney function recovery on days 1 (1.79 versus 2.39 mg/L), 2 (1.91 versus 2.38 mg/L), and 3 (2.04 versus 2.67 mg/L) of CKRT. Sieving coefficient and CKRT clearance of cystatin C were similar for patients with early and delayed kidney function recovery. The lowest plasma cystatin C concentration on days 1–3 of CKRT predicted early kidney function recovery with an area under the receiver operating curve of 0.77 (=0.002), positive likelihood ratio of 5.60 for plasma cystatin C <1.30 mg/L, and negative likelihood ratio of 0.17 for plasma cystatin C ≥1.88 mg/L.

CONCLUSIONS

Lower plasma cystatin C concentrations during the first 3 days of CKRT are associated with early kidney function recovery.

摘要

关键点

在需要持续肾脏替代治疗（CKRT）且肾功能早期恢复的急性肾损伤（AKI）患者中，血浆胱抑素C水平降低。尽管CKRT可清除血浆胱抑素C，但CKRT开始后前3天的血浆胱抑素C水平可能是有助于预测需要CKRT的AKI患者预后的有用临床指标。

背景

血浆胱抑素C是评估肾功能的可靠标志物；然而，在接受持续肾脏替代治疗（CKRT）的患者中其是否仍然如此尚不清楚。在本研究中，我们检验了以下假设：CKRT开始后前3天血浆胱抑素C浓度较低可预测肾功能恢复。

方法

我们对一项单中心CKRT研究中126例患者中的72例进行了回顾性观察研究。我们研究了两组无晚期慢性肾脏病（CKD）且患有需要CKRT的AKI患者：（1）肾功能早期恢复定义为CKRT开始后7天内脱离肾脏替代治疗；（2）肾功能延迟恢复定义为接受肾脏替代治疗超过21天或在接受肾脏替代治疗期间死亡。后续分析纳入了晚期CKD和肾功能中等恢复（8至21天脱离）的患者。然后对CKRT开始前以及CKRT第1、2和3天采集的储存血浆、尿液和透析流出液进行胱抑素C检测。

结果

在CKRT第1天（1.79对2.39mg/L）、第2天（1.91对2.38mg/L）和第3天（2.04对2.67mg/L），肾功能早期恢复患者的血浆胱抑素C水平显著低于肾功能延迟恢复患者。肾功能早期和延迟恢复患者的胱抑素C筛过系数和CKRT清除率相似。CKRT第1至3天的最低血浆胱抑素C浓度预测肾功能早期恢复，受试者工作特征曲线下面积为0.77（P=0.002），血浆胱抑素C<1.30mg/L时的阳性似然比为5.60，血浆胱抑素C≥1.88mg/L时的阴性似然比为0.17。