scholarly journals Clinical Utility of a Biomarker to Detect Contrast-Induced Acute Kidney Injury during Percutaneous Cardiovascular Procedures

2022 ◽  
pp. 1-9
Author(s):  
John Peabody ◽  
David Paculdo ◽  
Czarlota Valdenor ◽  
Peter A. McCullough ◽  
Eisei Noiri ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Clinical Utility ◽  
Fatty Acid Binding Protein ◽  
Kidney Injury ◽  
Accurate Diagnosis ◽  
Simulated Patients ◽  
Fatty Acid Binding ◽  
Acid Binding Protein ◽  
Post Procedure ◽  
Iodinated Contrast

<b><i>Introduction:</i></b> Contrast-induced acute kidney injury (CI-AKI) is a major clinical complication of percutaneous cardiovascular procedures requiring iodinated contrast. Despite its relative frequency, practicing physicians are unlikely to identify or treat this condition. <b><i>Methods:</i></b> In a 2-round clinical trial of simulated patients, we examined the clinical utility of a urine-based assay that measures liver-type fatty acid-binding protein (L-FABP), a novel marker of CI-AKI. We sought to determine if interventional cardiologists’ ability to diagnose and treat potential CI-AKI improved using the biomarker assay for 3 different patient types: pre-procedure, peri-procedure, and post-procedure patients. <b><i>Results:</i></b> 154 participating cardiologists were randomly divided into either control or intervention. At baseline, we found no difference in the demographics or how they identified and treated potential complications of AKI, with both groups providing less than half the necessary care to their patients (46.4% for control vs. 47.6% for intervention, <i>p</i> = 0.250). The introduction of L-FABP into patient care resulted in a statistically significant improvement of 4.6% (<i>p</i> = 0.001). Compared to controls, physicians receiving L-FABP results were 2.9 times more likely to correctly identify their patients’ risk for AKI (95% CI 2.1–4.0) and were more than twice as likely to treat for AKI by providing volume expansion and withholding nephrotoxic medications. We found the greatest clinical utility in the pre-procedure and peri-procedure settings but limited value in the post-procedure setting. <b><i>Conclusion:</i></b> This study suggests L-FABP as a clinical marker for assessing the risk of potential CI-AKI, has clinical utility, and can lead to more accurate diagnosis and treatment.

scholarly journals Performance of Urinary Liver-Type Fatty Acid–Binding Protein in Acute Kidney Injury: A Meta-analysis

2013 ◽  
Vol 61 (3) ◽  
pp. 430-439 ◽  
Author(s):  
Paweena Susantitaphong ◽  
Monchai Siribamrungwong ◽  
Kent Doi ◽  
Eisei Noiri ◽  
Norma Terrin ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Fatty Acid ◽  
Fatty Acid Binding Protein ◽  
Binding Protein ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Fatty Acid Binding ◽  
Acid Binding Protein

scholarly journals Clinical Usefulness of Urinary Liver Fatty Acid-Binding Protein Excretion for Predicting Acute Kidney Injury during the First 7 Days and the Short-Term Prognosis in Acute Heart Failure Patients with Non-Chronic Kidney Disease

2017 ◽  
Vol 7 (4) ◽  
pp. 301-315 ◽  
Author(s):  
Akihiro Shirakabe ◽  
Noritake Hata ◽  
Nobuaki Kobayashi ◽  
Hirotake Okazaki ◽  
Masato Matsushita ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Fatty Acid ◽  
Kidney Disease ◽  
Fatty Acid Binding Protein ◽  
Kidney Injury ◽  
Liver Fatty Acid ◽  
Fatty Acid Binding ◽  
Acid Binding Protein

Background: The clinical significance of urinary liver fatty acid-binding protein (u-LFABP) in acute heart failure (AHF) patients remains unclear. Methods and Results: The u-LFABP levels on admission of 293 AHF patients were analyzed. The patients were divided into 2 groups according to the u-LFABP quartiles (Q1, Q2, and Q3 = low u-LFABP [L] group vs. Q4 = high u-LFABP [H] group). We evaluated the diagnostic and prognostic value of u-LFABP and compared the findings between the chronic kidney disease (CKD; n = 165) and non-CKD patients (n = 128). Acute kidney injury (AKI) during the first 7 days was evaluated based on the RIFLE criteria. In the non-CKD group, the number of AKI patients during the first 7 days was significantly greater in the H group (70.0%) than in the L group (45.6%). A multivariate logistic regression model indicated that the H group (odds ratio: 3.850, 95% confidence interval [CI] 1.128-13.140) was independently associated with AKI during the first 7 days. The sensitivity and specificity of u-LFABP for predicting AKI were 63.6 and 59.7% (area under the ROC curve 0.631) at 41.9 ng/mg × cre. A Cox regression model identified the H group (hazard ratio: 13.494, 95% CI 1.512-120.415) as an independent predictor of the 60-day mortality. A Kaplan-Meier curve, including all-cause death within 60 days, showed a significantly poorer survival rate in the H group than in the L group (p = 0.036). Conclusions: The u-LFABP level is an effective biomarker for predicting AKI during the first 7 days of hospitalization and an adverse outcome in AHF patients with non-CKD.

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