Utility of suPAR and NGAL for AKI Risk Stratification and Early Optimization of Renal Risk Medications among Older Patients in the Emergency Department.

Autor:	Walls AB; Department of Drug Design and Pharmacology, University of Copenhagen, 2100 Copenhagen, Denmark.; The Capital Region Pharmacy, 2730 Herlev, Denmark., Bengaard AK; Department of Drug Design and Pharmacology, University of Copenhagen, 2100 Copenhagen, Denmark.; Department of Clinical Research, Copenhagen University Hospital-Amager and Hvidovre, 2650 Copenhagen, Denmark.; Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark., Iversen E; Department of Clinical Research, Copenhagen University Hospital-Amager and Hvidovre, 2650 Copenhagen, Denmark., Nguyen CN; Department of Drug Design and Pharmacology, University of Copenhagen, 2100 Copenhagen, Denmark.; The Capital Region Pharmacy, 2730 Herlev, Denmark.; Department of Clinical Research, Copenhagen University Hospital-Amager and Hvidovre, 2650 Copenhagen, Denmark., Kallemose T; Department of Clinical Research, Copenhagen University Hospital-Amager and Hvidovre, 2650 Copenhagen, Denmark., Juul-Larsen HG; Department of Clinical Research, Copenhagen University Hospital-Amager and Hvidovre, 2650 Copenhagen, Denmark., Jawad BN; Department of Clinical Research, Copenhagen University Hospital-Amager and Hvidovre, 2650 Copenhagen, Denmark.; Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark.; Emergency Department, Copenhagen University Hospital-Amager and Hvidovre, 2650 Hvidovre, Denmark., Hornum M; Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark.; Department of Nephrology, Copenhagen University Hospital-Rigshospitalet, 2100 Copenhagen, Denmark., Andersen O; Department of Clinical Research, Copenhagen University Hospital-Amager and Hvidovre, 2650 Copenhagen, Denmark.; Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark.; Emergency Department, Copenhagen University Hospital-Amager and Hvidovre, 2650 Hvidovre, Denmark., Eugen-Olsen J; Department of Clinical Research, Copenhagen University Hospital-Amager and Hvidovre, 2650 Copenhagen, Denmark., Houlind MB; Department of Drug Design and Pharmacology, University of Copenhagen, 2100 Copenhagen, Denmark.; The Capital Region Pharmacy, 2730 Herlev, Denmark.; Department of Clinical Research, Copenhagen University Hospital-Amager and Hvidovre, 2650 Copenhagen, Denmark.
Jazyk:	angličtina
Zdroj:	Pharmaceuticals (Basel, Switzerland) [Pharmaceuticals (Basel)] 2021 Aug 25; Vol. 14 (9). Date of Electronic Publication: 2021 Aug 25.
DOI:	10.3390/ph14090843
Abstrakt:	Diagnosis of acute kidney injury (AKI) based on plasma creatinine often lags behind actual changes in renal function. Here, we investigated early detection of AKI using the plasma soluble urokinase plasminogen activator receptor (suPAR) and neutrophil gelatinase-sssociated lipocalin (NGAL) and observed the impact of early detection on prescribing recommendations for renally-eliminated medications. This study is a secondary analysis of data from the DISABLMENT cohort on acutely admitted older (≥65 years) medical patients ( n = 339). Presence of AKI according to kidney disease: improving global outcomes (KDIGO) criteria was identified from inclusion to 48 h after inclusion. Discriminatory power of suPAR and NGAL was determined by receiver-operating characteristic (ROC). Selected medications that are contraindicated in AKI were identified in Renbase ® . A total of 33 (9.7%) patients developed AKI. Discriminatory power for suPAR and NGAL was 0.69 and 0.78, respectively, at a cutoff of 4.26 ng/mL and 139.5 ng/mL, respectively. The interaction of suPAR and NGAL yielded a discriminatory power of 0.80, which was significantly higher than for suPAR alone ( p = 0.0059). Among patients with AKI, 22 (60.6%) used at least one medication that should be avoided in AKI. Overall, suPAR and NGAL levels were independently associated with incident AKI and their combination yielded excellent discriminatory power for risk determination of AKI.
Databáze:	MEDLINE
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