Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02180-w

Evaluation of tubular markers as prognostic markers for acute kidney injury in dependence of plasma volume status in patients with contrast medium exposure and severe aortic valve stenosis

A. Schober1, C. Heidel1, N. Roth1, C. M. Xu2, M. Schlossbauer1, U. Hubauer1, A. Schober1, M. Schober3, L. S. Maier1, A. Luchner4, C. G. Jungbauer1, K. Debl1

1Klinik und Poliklinik für Innere Med. II, Kardiologie, Universitätsklinikum Regensburg, Regensburg; 2Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg; 3Nephrologie, Universitätsklinikum Regensburg, Regensburg; 4Klinik für Kardiologie, Krankenhaus Barmherzige Brüder Regensburg, Regensburg;

Background Patients with  severe aortic valve stenosis undergoing examinations with exposure to contrast medium are at risk of suffering from acute kidney Injury due to contrast medium and the underlying disease. Our goal was to examine the tubular markers N-acetyl-ß-D-glucosaminidase (NAG) and kidney injury molecule-1 (KIM-1) as prognostic markers for acute kidney injury in patients with exposure to contrast medium and severe aortic valve stenosis. Methods 135 patients with severe aortic valve stenosis undergoing evaluation for TAVR including a CT scan and/or a coronary angiography were included in this prospective study. NAG and KIM-1 were measured in urine samples before and 6h after exposure to contrast medium and creatinine was measured on a regular basis. All biomarker concentrations were related to urinary creatinine to minimize dilutional bias. Volume status was objectivated according to Plasma Volume Status (PVS). Results 26 (19.2%) patients suffered from acute kidney injury during the first 72h after exposure to contrast medium. Those patients had significantly higher levels of creatinine, but there was no significant difference in age, prevalence of diabetes, hypertension or chronic kidney failure. Patients suffering from AKI after exposure to contrast medium had significantly higher levels of NAG before the exposure (p < 0.05). 6h after the examination, there was no significant difference between patients with AKI and without AKI. Also, there was no significant change in NAG levels evident (each p=n.s.). After separating patients in regard of plasma volume status (PVS </> median), ROC analyses showed an AUC of 0,72    to predict an AKI after contrast medium exposure in patients with a low plasma volume status (PVS > median  ) with a sensitivity of 0,9 and a specificity of 0,55 (cut-off 4.7 U/gCr). 6h after exposure to contrast medium, the predictive value of NAG decreased (AUC 0.65) and there was no significant difference in NAG levels 6h after exposure to contrast medium. In patients with high plasma volume status NAG showed no predictive value in ROC analyses (AUC 0.56) before exposure to contrast medium as well as 6h after the exposure (AUC 0.42). There was no significant difference in KIM-1 levels at any time. Conclusion In this study, NAG presented itself as putative predictor for an acute kidney injury in patients with contrast medium exposure, severe aortic valve stenosis and no volume overload in the short term. This could not be shown for KIM-1.

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