Biomarkers in the prediction of contrast media induced nephropathy – the BITCOIN study

• Published in: PloS one Vol. 15; no. 7; p. e0234921
• Main Authors: Seibert, Felix S., Heringhaus, Anja, Pagonas, Nikolaos, Rudolf, Henrik, Rohn, Benjamin, Bauer, Frederic, Timmesfeld, Nina, Trappe, Hans-Joachim, Babel, Nina, Westhoff, Timm H.
• Format: Journal Article
• Language: English
• Published: San Francisco Public Library of Science 16.07.2020; Public Library of Science (PLoS)
• Subjects: Acute kidney failure; Albumins; Analysis; Angiography; Biological markers; Biology and Life Sciences; Biomarkers; Complications and side effects; Contrast media; Creatinine; Diagnosis; Epidemiology; Epidermal growth factor receptors; Gelatinase; Glomerular filtration rate; Health risks; Inflammation; Kidney diseases; Kidneys; Lipocalin; Medical imaging; Medicine and Health Sciences; Nephropathy; Prognosis; Proteinuria; Research and Analysis Methods; Risk; Risk factors; Germany; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0234921

Subjects with chronic kidney disease are at increased risk for contrast-induced acute kidney injury (CI-AKI). Risk stratification is traditionally based on glomerular filtration rate (GFR) and proteinuria. The present trial examines, whether tubular and inflammatory biomarkers are able to identify subjects at increased risk as well. We performed a prospective study in 490 patients undergoing coronary angiography. An increase of serum creatinine concentration [greater than or equal to] 0.3 mg/dl from baseline to day 2-3 was defined as primary endpoint (CI-AKI). Urinary neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), and calprotectin were assessed < 24h before coronary angiography. Prognostic accuracy was assessed by receiver operating characteristics (ROC) calculations. 30 (6.1%) patients suffered from CI-AKI (27 AKIN stage I, 3 AKIN stage II, 0 AKIN stage III). Those subjects who developed CI-AKI had 3.1 fold higher baseline urinary NGAL/creatinine ratios than those without CI-AKI (60.8 [IQR 18.7-93.1] [mu]g/mg vs. 19.9 [IQR 12.3-38.9] [mu]g/mg, p = 0.001). In those subjects without clinically overt CKD (eGFR > 60 ml/min, urinary albumin creatinine ratio 0.05 each). ROC analyses revealed an area under the curve (AUC) of 0.68 (95% CI 0.60-0.81) for NGAL/creatinine. An NGAL/creatinine ratio < 56.4 [mu]g/mg has a negative predictive value of 96.5%. The present study is the largest investigation on the use of urinary biomarkers for CI-AKI risk stratification so far. It shows that NGAL provides prognostic information beyond the glomerular biomarkers eGFR and proteinuria.