Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2013 May;61(5):730-8.
doi: 10.1053/j.ajkd.2012.12.006. Epub 2013 Jan 16.

Urinary cystatin C and acute kidney injury after cardiac surgery

Jay L Koyner  1 , Amit X Garg, Michael G Shlipak, Uptal D Patel, Kyaw Sint, Kwangik Hong, Prasad Devarajan, Charles L Edelstein, Michael Zappitelli, Heather Thiessen-Philbrook, Chirag R Parikh; Translational Research Investigating Biomarker Endpoints in AKI (TRIBE AKI) Consortium
Collaborators, Affiliations
Randomized Controlled Trial

Urinary cystatin C and acute kidney injury after cardiac surgery

Jay L Koyner et al. Am J Kidney Dis. 2013 May.

Abstract

Background: Acute kidney injury (AKI) is common after cardiac surgery and is associated with adverse patient outcomes. Urinary cystatin C (CysC) level is a biomarker of proximal tubule function and may increase earlier in AKI than serum creatinine level.

Study design: Prospective cohort study.

Settings & participants: The TRIBE AKI (Translational Research Investigating Biomarker Endpoints in AKI) Consortium prospectively enrolled 1,203 adults and 299 children and adolescents at 8 institutions in 2007-2009.

Index test: Urinary CysC (in milligrams per liter) within the first 12 hours after surgery.

Outcome: Serum creatinine-based AKI was defined as AKI Network stage 1 (mild AKI) and doubling of serum creatinine from the preoperative value or need for dialysis during hospitalization (severe AKI).

Other measurements: Analyses were adjusted for characteristics used clinically for AKI risk stratification, including age, sex, race, estimated glomerular filtration rate, diabetes, hypertension, heart failure, nonelective surgery, cardiac catheterization within 72 hours, type of surgery, myocardial infarction, and cardiopulmonary bypass time longer than 120 minutes.

Results: Urinary CysC level measured in the early postoperative period (0-6 and 6-12 hours postoperatively) correlated with both mild and severe AKI in adults and children. However, after analyses were adjusted for other factors, the effect was attenuated for both forms of AKI in both cohorts.

Limitations: Limited numbers of patients with severe AKI and in-hospital dialysis treatment.

Conclusions: Urinary CysC values are not associated significantly with the development of AKI after cardiac surgery in adults and children.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Figure 1A, 1B, 1C and 1D: Urine Cystatin C levels over time after surgery in adults and children Figure 1A and 1B displays the UCyCs concentrations in adults (1A) and children (1B) over time for those who did and did not develop Mild AKI. Mild AKI defined as AKIN Stage 1 or higher. Figure 1C and 1D displays the UCyCs concentrations in adults (1C) and children (1D) over time for those who did and did not develop Severe AKI. Severe AKI defined as 100% increase from preoperative baseline or the receipt of short-term dialysis. For each timepoint, the line indicates the median and the bottom and top of the box indicates the 25th and 75th percentile of urine cystatin C among patients with AKI (blue) and without AKI (green) patients. Yellow bars indicate the 25th to 75th percentile day of the initial creatinine-based diagnosis of AKI
See this image and copyright information in PMC

References

    1. Chertow G, Levy E, Hammermeister K, Grover F, Daley J. Independent association between acute renal failure and mortality following caridac surgery. Am J Med. 1998;104:343–348. - PubMed
    1. Wijeysundera DN, Karkouti K, Dupuis JY, et al. Derivation and validation of a simplified predictive index for renal replacement therapy after cardiac surgery. Jama. 2007;297:1801–1809. - PubMed
    1. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P. Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004;8:R204–212. - PMC - PubMed
    1. Brown JR, Kramer RS, Coca SG, Parikh CR. Duration of acute kidney injury impacts long-term survival after cardiac surgery. Ann Thorac Surg. 2010;90:1142–1148. - PMC - PubMed
    1. Dasta JF, Kane-Gill SL, Durtschi AJ, Pathak DS, Kellum JA. Costs and outcomes of acute kidney injury (AKI) following cardiac surgery. Nephrol Dial Transplant. 2008;23:1970–1974. - PubMed

Publication types

MeSH terms