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

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@article{a4d25eaa0c5c4251bae73d244fc018d5,
title = "Utility of suPAR and NGAL for AKI Risk Stratification and Early Optimization of Renal Risk Medications among Older Patients in the Emergency Department",
abstract = "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{\textregistered}. 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.",
keywords = "Acute kidney injury, Early biomarker, Emergency department, Medication optimization, Older patients, Plasma neutrophil gelatinase‐associated lipocalin, Soluble urokinase plasminogen activator receptor",
author = "Walls, {Anne Byriel} and Bengaard, {Anne Kathrine} and Esben Iversen and Nguyen, {Camilla Ngoc} and Thomas Kallemose and Juul-Larsen, {Helle Gybel} and Jawad, {Baker Nawfal} and Mads Hornum and Ove Andersen and Jesper Eugen-Olsen and Houlind, {Morten Baltzer}",
year = "2021",
month = aug,
day = "25",
doi = "10.3390/ph14090843",
language = "English",
volume = "14",
pages = "1--15",
journal = "Pharmaceuticals",
issn = "1424-8247",
publisher = "M D P I AG",
number = "9",

}

RIS

TY - JOUR

T1 - Utility of suPAR and NGAL for AKI Risk Stratification and Early Optimization of Renal Risk Medications among Older Patients in the Emergency Department

AU - Walls, Anne Byriel

AU - Bengaard, Anne Kathrine

AU - Iversen, Esben

AU - Nguyen, Camilla Ngoc

AU - Kallemose, Thomas

AU - Juul-Larsen, Helle Gybel

AU - Jawad, Baker Nawfal

AU - Hornum, Mads

AU - Andersen, Ove

AU - Eugen-Olsen, Jesper

AU - Houlind, Morten Baltzer

PY - 2021/8/25

Y1 - 2021/8/25

N2 - 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.

AB - 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.

KW - Acute kidney injury

KW - Early biomarker

KW - Emergency department

KW - Medication optimization

KW - Older patients

KW - Plasma neutrophil gelatinase‐associated lipocalin

KW - Soluble urokinase plasminogen activator receptor

UR - http://www.scopus.com/inward/record.url?scp=85114029211&partnerID=8YFLogxK

U2 - 10.3390/ph14090843

DO - 10.3390/ph14090843

M3 - Journal article

C2 - 34577543

VL - 14

SP - 1

EP - 15

JO - Pharmaceuticals

JF - Pharmaceuticals

SN - 1424-8247

IS - 9

M1 - 843

ER -

ID: 67889504