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Single value of NephroCheck™ performed at 4 hours after surgery does not predict acute kidney injury in off-pump coronary artery bypass surgery


1 Department of Anaesthesia and Intensive Care, Narayana Institute of Cardiac Sciences, Narayana Health City, Bangalore, Karnataka, India
2 Department of Cardiac Anaesthesia, Narayana Superspeciality Hospital, Gurugram, Haryana, India
3 Department of Clinical Research, Narayana Health City, Bangalore, Karnataka, India
4 Department of Cardiac Critical Care, Narayana Institute of Cardiac Sciences, Narayana Health City, Bangalore, Karnataka, India
5 Department of Anaesthesia, University of Minnesota, Minneapolis, MN, USA

Correspondence Address:
Muralidhar Kanchi
Department of Anaesthesia and Intensive Care, Narayana Institute of Cardiac Sciences, Narayana Health City, Bangalore - 560 099, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aca.aca_56_21

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Year : 2023  |  Volume : 26  |  Issue : 1  |  Page : 57-62

 

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Background: Quantification of urinary tissue inhibitor of metalloproteinase-2 (TIMP-2) and insulin-like growth factor binding protein (IFGBP-7), which is commercially known as NephroCheck™(NC) test have been suggested as promising tools for the early detection of acute kidney injury (AKI) after cardiac surgery involving cardio-pulmonary bypass (CPB). Objectives: The aim of the present study was to test the hypothesis that single value of postoperative NC test performed at 4 hours after surgery can predict AKI in off-pump coronary artery bypass grafting (OPCABG) surgery. Setting and Design: This prospective single-center study was conducted at the tertiary cardiac center in India from December 2017 to November 2018. Methods: Ninety adult patients of both sex undergoing elective OPCABG were included. Anesthesia was standardized to all patients. Urine samples were collected preoperatively and at 4 hours after surgery for NC test. Urine output, serum creatinine, estimated glomerular filtration rate (eGFR) were also measured. AKI staging was based on kidney disease improving global outcomes (KDIGO) guidelines. Statistical Analysis: To assess the predictability of NC test for the primary endpoint, area under the receiver operating characteristic curve (ROC), was calculated. Results: Thirteen patients developed AKI in the study cohort (14.4%) out of which 7 patients (7.8%) developed stage 2/3 AKI and the remaining stage 1 AKI. Baseline renal parameters were similar between AKI and non-AKI group. The area under curve (AUC) of NC test at 4 hours after surgery was 0.60 [95% confidence interval (CI): 0.42-0.77]. Postoperative NC test performed at 4 hours after surgery did not predict AKI in this study population (P = 0.24). There were no significant differences in duration of mechanical ventilation, length of intensive care stay and hospital stay between the two groups (P > 0.05). Conclusion: NephroCheck test performed at 4 hours after surgery did not identify patients at risk for developing AKI following OPCABG surgery.






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1 Department of Anaesthesia and Intensive Care, Narayana Institute of Cardiac Sciences, Narayana Health City, Bangalore, Karnataka, India
2 Department of Cardiac Anaesthesia, Narayana Superspeciality Hospital, Gurugram, Haryana, India
3 Department of Clinical Research, Narayana Health City, Bangalore, Karnataka, India
4 Department of Cardiac Critical Care, Narayana Institute of Cardiac Sciences, Narayana Health City, Bangalore, Karnataka, India
5 Department of Anaesthesia, University of Minnesota, Minneapolis, MN, USA

Correspondence Address:
Muralidhar Kanchi
Department of Anaesthesia and Intensive Care, Narayana Institute of Cardiac Sciences, Narayana Health City, Bangalore - 560 099, Karnataka
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aca.aca_56_21

Rights and Permissions

Background: Quantification of urinary tissue inhibitor of metalloproteinase-2 (TIMP-2) and insulin-like growth factor binding protein (IFGBP-7), which is commercially known as NephroCheck™(NC) test have been suggested as promising tools for the early detection of acute kidney injury (AKI) after cardiac surgery involving cardio-pulmonary bypass (CPB). Objectives: The aim of the present study was to test the hypothesis that single value of postoperative NC test performed at 4 hours after surgery can predict AKI in off-pump coronary artery bypass grafting (OPCABG) surgery. Setting and Design: This prospective single-center study was conducted at the tertiary cardiac center in India from December 2017 to November 2018. Methods: Ninety adult patients of both sex undergoing elective OPCABG were included. Anesthesia was standardized to all patients. Urine samples were collected preoperatively and at 4 hours after surgery for NC test. Urine output, serum creatinine, estimated glomerular filtration rate (eGFR) were also measured. AKI staging was based on kidney disease improving global outcomes (KDIGO) guidelines. Statistical Analysis: To assess the predictability of NC test for the primary endpoint, area under the receiver operating characteristic curve (ROC), was calculated. Results: Thirteen patients developed AKI in the study cohort (14.4%) out of which 7 patients (7.8%) developed stage 2/3 AKI and the remaining stage 1 AKI. Baseline renal parameters were similar between AKI and non-AKI group. The area under curve (AUC) of NC test at 4 hours after surgery was 0.60 [95% confidence interval (CI): 0.42-0.77]. Postoperative NC test performed at 4 hours after surgery did not predict AKI in this study population (P = 0.24). There were no significant differences in duration of mechanical ventilation, length of intensive care stay and hospital stay between the two groups (P > 0.05). Conclusion: NephroCheck test performed at 4 hours after surgery did not identify patients at risk for developing AKI following OPCABG surgery.






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