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. 2011 Oct;6(10):2340-6.
doi: 10.2215/CJN.01000211. Epub 2011 Sep 1.

Urinary hepcidin-25 and risk of acute kidney injury following cardiopulmonary bypass

Julie Ho  1 , Martina Reslerova, Brent Gali, Ang Gao, Jennifer Bestland, David N Rush, Peter W Nickerson, Claudio Rigatto
Affiliations

Urinary hepcidin-25 and risk of acute kidney injury following cardiopulmonary bypass

Julie Ho et al. Clin J Am Soc Nephrol. 2011 Oct.

Abstract

Background and objectives: Acute kidney injury (AKI) complicating cardiopulmonary bypass (CPB) results in increased morbidity and mortality. Urinary hepcidin-25 has been shown to be elevated in patients who do not develop AKI after CPB using semiquantitative mass spectrometry (SELDI TOF-MS). The goals of this study were to quantitatively validate these findings with ELISA and evaluate the diagnostic performance of hepcidin-25 for AKI.

Design, setting, participants, & measurements: A nested, case-control analysis of urinary hepcidin-25 in AKI (n = 22) and non-AKI (n = 22) patients was conducted to validate the SELDI TOF-MS data at the following times: preoperatively; the start of CPB; 1 hour on CPB; on arrival to the intensive care unit; and postoperative days (POD) 1 and 3 to 5. The diagnostic performance of hepcidin-25 was then evaluated in the entire prospective observational cohort (n = 338) at POD 1. AKI was defined as Cr >50% from baseline, within 72 hours postoperatively.

Results: Urinary hepcidin-25/Cr ratio was significantly elevated in all patients at POD 1 compared with baseline (P < 0.0005) and was also significantly elevated in non-AKI versus AKI patients at POD 1 (P < 0.0005). Increased log(10) hepcidin-25/Cr ratio was strongly associated with avoidance of AKI on univariate analysis. On multivariate analysis, the log(10) hepcidin-25/Cr ratio (P < 0.0001) was associated with avoidance of AKI with an area under the curve of 0.80, sensitivity 0.68, specificity 0.68, and negative predictive value 0.96.

Conclusions: Elevated urinary hepcidin-25 on POD 1 is a strong predictor of avoidance of AKI beyond postoperative day 1.

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Figures

Figure 1.
Figure 1.
Derivation of the nested case-control (n = 44) and prospective observational cohort (n = 338). The diagram for the nested case-control cohort is adapted from reference . AKI, acute kidney injury; eGFR, estimated GFR; POD, postoperative day; OR, operating room.
Figure 2.
Figure 2.
Urinary hepcidin-25/Cr ratio is elevated in all patients at postoperative day 1 (POD 1) compared with baseline (P < 0.0005) and is significantly increased in non–acute kidney injury versus AKI patients at POD 1 (P < 0.0005). OR, operating room; CPB, cardiopulmonary bypass; ICU, intensive care unit.
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