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Urinary biomarkers associated with acute kidney injury in pediatric mechanical circulatory support patients

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Abstract

Background

In patients requiring mechanical circulatory support (MCS), the incidence of acute kidney injury (AKI) is between 37 and 63%. In this study, we performed an exploratory analysis evaluating the relationship of multiple urine biomarkers with AKI development in pediatric MCS patients.

Methods

This is a single center retrospective study in a pediatric cohort receiving MCS from August 2014 to November 2020. We measured 14 urine biomarkers of kidney injury on day 1 following MCS initiation and analyzed their association with development of AKI in the first 7 days of MCS initiation.

Results

Sixty patients met inclusion criteria. Patients with AKI were more likely to be supported by venoarterial extracorporeal membrane oxygenation (65% vs. 8.3%, p < 0.001), compared to the no AKI group and less likely to have ventricular assist devices (10% vs. 50%, p < 0.001). There was a significant increase in the median urine albumin and urine osteoactivin in the AKI group, compared to the no AKI group (p = 0.020 and p = 0.018, respectively). When normalized to urine creatinine (UCr), an increased log osteoactivin/UCr was associated with higher odds of AKI development (OR: 2.05; 95% CI: 1.07, 4.44; p = 0.028), and higher log epidermal growth factor (EGF)/UCr (OR: 0.41; 95% CI: 0.15, 0.96) was associated with decreased odds of AKI.

Conclusions

Early increase in urine osteoactivin is associated with AKI development within 7 days of MCS initiation in pediatric patients. Contrary, an increased urine EGF is associated with kidney protection.

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Acknowledgements

We acknowledge the support of the ECMO and clinical teams in the PICU, NICU, and CTICU, at Nationwide Children’s Hospital.

Funding

This work was supported by a grant from the Nationwide Children’s Heart Center intramural program (51108–0005-1222).

Author information

Authors and Affiliations

  1. Division of Pediatric Cardiology, Nationwide Children’s Hospital, Columbus, OH, USA

    Rachel E. Harris, Andrew R. Yates, Deipanjan Nandi, Catherine D. Krawczeski, Brian F. Beckman & Jianli Bi

  2. Division of Pediatric Critical Care Medicine, Nationwide Children’s Hospital, Columbus, OH, USA

    Andrew R. Yates & Catherine D. Krawczeski

  3. Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA

    Andrew R. Yates, Deipanjan Nandi, Catherine D. Krawczeski & Diana Zepeda-Orozco

  4. Biostatistics Resource at Nationwide Children’s Hospital, Columbus, OH, USA

    Brett Klamer

  5. Kidney and Urinary Tract Center, Abigail Wexner Research Institute at Nationwide Children’s, Columbus, OH, USA

    Gabriela Vasquez Martinez, Gabriel Mayoral Andrade & Diana Zepeda-Orozco

  6. Center for Cardiovascular Research, Nationwide Children’s Hospital, Columbus, OH, USA

    Brian F. Beckman & Jianli Bi

  7. Division of Nephrology and Hypertension, Nationwide Children’s Hospital, Columbus, OH, USA

    Diana Zepeda-Orozco

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  1. Rachel E. Harris
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Correspondence to Rachel E. Harris.

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Supplementary figure 1

Adjusted relationship between selected biomarkers and the probability of stage 2 or 3 AKI. The shaded region shows 95% confidence limits. UCr, urine creatinine (mg/mL); EGF, epidermal growth factor (ng/mL); NGAL, neutrophil gelatinase-associated lipocalin (ng/mL); KIM-1, kidney injury molecule-1 (ng/mL) (PNG 242 kb)

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Harris, R.E., Yates, A.R., Nandi, D. et al. Urinary biomarkers associated with acute kidney injury in pediatric mechanical circulatory support patients. Pediatr Nephrol 39, 569–577 (2024). https://doi.org/10.1007/s00467-023-06089-4

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