RENAL ARTERIAL RESISTIVE INDEX VERSUS URINARY BIOMARKERS FOR PREDICTION OF CRUSH RELATED ACUTE KIDNEY INJURY (CR-AKI) - International Society of Nephrology Events

E-Poster

https://storage.unitedwebnetwork.com/files/1099/907b36328c6ffd402ebfbfa63fa2b956.pdf

Abstract Title

RENAL ARTERIAL RESISTIVE INDEX VERSUS URINARY BIOMARKERS FOR PREDICTION OF CRUSH RELATED ACUTE KIDNEY INJURY (CR-AKI)

First Name *

TANVIR

Last Name *

SAMRA

Co-author 1

Kalaiyarasan S s.kalaiyarasan3110@gmail.com PGIMER, Chandigarh Department of Anaesthesia and Intensive Care Chandigarh

Co-author 2

Kajal Jain kajalteji@gmail.com PGIMER Department of Anaesthesia and Intensive care Chandigarh

Co-author 3

Vinod Kumar vinsh777@gmail.com PGIMER Department of Dermatology, Venerology and Leprology Chandigarh

Co-author 4

Raja Ramachandran drraja1980@gmail.com PGIMER, Department of Nephrology Chandigarh

Co-author 5

Co-author 6

Co-author 7

Co-author 8

Co-author 9

Co-author 10

Co-author 11

Co-author 12

Co-author 13

Co-author 14

Co-author 15

Introduction

Introduction: Crush injury related acute kidney injury (CR-AKI) needs to be recognized early to enable initiation of renal protection strategies. Primary objective of this study was to compare the diagnostic performance of urinary biomarker (product of TIMP-2 and IGFBP-7) vs RRI in predicting AKI

Methods

Adult patients with a history suggestive of crush injury were recruited prospectively from the triage of a level 1 trauma centre from September 2022 – June 2023. Measurements of RRI and collection of urine samples for IGFBP-7 and TIMP -2 were done thrice (within 2 hours of admission, 24 and 48 hours). AKI was diagnosed using KDIGO criteria based on serum creatinine values analysed on a daily basis till 7th day of hospital admission.

Results

Clinical and demographic data was collected from 118 patients (140 were assessed; 22 were excluded). Incidence of CR-AKI was 33.05%. RRI was significantly higher at all time points in patients developing AKI. Product of TIMP-2 and IGFBP-7 at all time points in both the groups expressed as (ng/ml)2 /1000 were > 0.3 and the difference in values in the AKI vs non AKI groups was significantly different at 2 hours and 48hrs. Best diagnostic parameter for CR-AKI was RRI at 24 hours; area under ROC (AUROC) curve was 0.744. At a cut off of RRI ≥0.665 it predicted AKI with a sensitivity, specificity, NPV, OR of 78.9%, 69.6%, 87.3% , 8.59 (p= <0.001) respectively. AUROC was <0.7 for all urinary biomarkers

Table 1: Demographic and clinical characteristics of overall cohort with crush injury and subsequent subgroup; AKI vs non AKI

Parameters

Overall (n=118)

AKI (n=39)

Non AKI (n=79)

P value

Age (years)

Weight (kg)

Height (cm)

BMI (Kg/m²)

Male:Female*

34.75 ±13.38

70.64 ±11.31

167.05±8.32

25.41 ±3.87

108:10

35.41±13.54

70.13±10.91

167.54±8.96

25.34±3.96

37:2

34.42±13.38

70.89±11.57

166.81±8.04

25.44±3.85

71:8

0.693

0.635

0.515

0.630

0.494

ASA class I:II*

99:19

31:8

68:11

0.360

Delay in Admission#

<24 Hours

24-48 Hours

>48 Hours

Conclusions

All patients with crush injury are at risk of AKI. RRI performs better than urinary biomarkers for early diagnosis of AKI.

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