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. 2017 Apr-Jun;7(2):94-99.
doi: 10.4103/2229-516X.205811.

Performance Characteristics of Kidney Injury Molecule-1 In Relation to Creatinine, Urea, and Microalbuminuria in the Diagnosis of Kidney Disease

Musalula Sinkala  1 , Mildred Zulu  2 , Trevor Kaile  2 , Marah Simakando  2 , Chisanga Chileshe  3 , Doris Kafita  1 , Panji Nkhoma  1
Affiliations

Performance Characteristics of Kidney Injury Molecule-1 In Relation to Creatinine, Urea, and Microalbuminuria in the Diagnosis of Kidney Disease

Musalula Sinkala et al. Int J Appl Basic Med Res. 2017 Apr-Jun.

Abstract

Context: The diagnosis and evaluation of impaired renal function remains a challenge owing to lack of reliable biomarker for assessment of kidney function. The existing panel of biomarkers currently displays several limitations, and recently kidney injury molecule-1 (KIM-1) has been suggested as a sensitive biomarker of renal function and proposed to enter clinical practice.

Aims: This study was conducted to determine the diagnostic value of serum creatinine, urea, and microalbuminuria (MAU) in relation to the novel biomarker, KIM-1.

Materials and methods: Serum creatinine, urea, MAU, and KIM-1 were measured in forty individuals with and forty without kidney disease. Data were analyzed using multivariate methods of assessing diagnostic efficiency, test agreement, condition effects, and variability.

Results: The area under the receiver-operator characteristic curve revealed a diagnostic advantage of creatinine (0.924 ± 0.0066) and urea (0.925 ± 0.0068) over MAU (0.880 ± 0.078) and KIM-1 (0.35 ± 0.124). Overall diagnostic efficiency was higher for creatinine and urea (89.5% and 90.9%, respectively), followed by MAU (85.7%) and then KIM-1 (56.3%). Logistic regression analysis showed that creatinine and urea (R2 = 0.75 and R2 = 0.72, respectively, P < 0.001 for both) were better predictors of kidney disease than MAU (R2 = 0.64, P < 0.001) and KIM-1 (R2 = 0.046, P = 0.116). Further analysis of agreement showed that urea had an excellent agreement with creatinine (kappa r = 0.835, P < 0.001), with KIM-1 (kappa r = -0.198, P = 0.087) showing a poor agreement with creatinine.

Conclusion: Our results indicate that elevated serum creatinine and urea above specific cutoff points reliably identifies patients with acute kidney injury or chronic kidney disease. However, more researches are warranted to further validate the diagnostic efficiency and application of MAU and for KIM-1 before its implementation in clinical practice.

Keywords: Creatinine; diagnostic accuracy; kidney disease; kidney injury molecule-1; microalbuminuria; urea.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Receiver–operator characteristic curves for the best prediction model of kidney disease. The area under the receiver–operator characteristic curve values and 95% confidence intervals and P values
Figure 2
Figure 2
Interaction between kidney biomarkers with gender and kidney status: two-way analysis of variance showed that main effect kidney status was associated with creatinine (P < 0.001) (a), urea (P < 0.001) (b), and microalbuminuria (P < 0.001) (d) but not for kidney injury molecule-1 (P = 0.096) (c)
Figure 3
Figure 3
Mean serum creatinine levels of individuals with normal kidney function
See this image and copyright information in PMC

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