Long-term Prognosis of Acute Kidney Injury in Cardiac Surgery

描述（由申请人提供）： 众所周知，急性肾损伤（阿基）对临床结局（包括短期死亡率）有显着影响。然而，阿基的发病率在过去几年中有所增加。同时，慢性肾脏疾病的患病率很高，并导致美国患者和医疗保健系统的重大负担。目前还不清楚阿基是否是一种完全可逆的疾病，或者它是否会导致永久性肾损伤，从而导致CKD和死亡。 该提案将采用前瞻性队列设计，将在正在进行的心脏手术后检测阿基的尿液生物标志物的5天多中心研究中增加长期随访部分。我们将在三个学术中心纵向研究阿基患者（定义为围手术期血清肌酸酐至少增加25%）和同等数量在心脏手术中存活的无阿基患者。我们将确定阿基是否会导致肾小球滤过率下降的增加和蛋白质排泄率随时间的增加。我们将比较伴有和不伴有阿基的患者血清肌酐加倍、透析或死亡的发生率。此外，我们将检查新发现的急性肾损伤生物标志物（尿IL-18和NGAL）是否与CKD和死亡相关。由于肌钙蛋白在心肌梗死中显示出巨大的价值，我们希望这些尿生物标志物对阿基患者具有长期预后价值。 目前，大多数医生认为阿基是一种可逆的现象，在急性期后几乎没有后果。然而，如果阿基确实与长期发病率和死亡率相关，那么这些患者的AKI后护理应包括更密切的警惕和更积极的治疗，以改善长期结局。我希望在未来获得R 01赠款，以改善阿基的风险分层，我还希望参与阿基及其相关并发症治疗的多中心试验。 公共卫生相关性：急性肾损伤与长期结局之间的关系尚不清楚。这些研究将试图确定传统肾脏暴露变量（例如，血清肌酸酐的急性变化）和新的肾脏暴露变量（例如，尿生物标志物）和长期肾脏和死亡率结果。

DESCRIPTION (provided by applicant): It is well known that acute kidney injury (AKI) has a marked impact on clinical outcomes, including short-term mortality. Futhermore, the incidence of AKI has increased over the past several years. At the same time, the prevalence of chronic kidney disease is high and results in a major burden for patients and for the health care system in the United States. It is unclear if AKI is a completely reversible disease, or whether it leads to permanent kidney damage and thus CKD and death. This proposal will utilize a prospective cohort design that will add a long-term follow-up component to an ongoing multi-center 5-day study of urinary biomarkers for the detection of AKI after cardiac surgery. We will longitudinally study the patients with AKI as defined by at least a 25% increase in peri-operative serum creatinine and an equal number of patients without AKI that survive cardiac surgery at three academic centers. We will determine if AKI results in an increase in the decline in glomerular filtration rate and in increase in the protein excretion rate over time. We will compare the incidence of doubling of serum creatinine, dialysis or death in patients with and without AKI. In addition, we will examine if newly discovered biomarkers of acute kidney injury (urinary IL-18 and NGAL) are associated with CKD and death. As troponin has shown tremendous value in the setting of myocardial infarction, our hope is that these urinary biomarkers will possess long-term prognostic value for patients with AKI. Currently, AKI is viewed by most physicians as a reversible phenomenon that has little consequence after the acute phase. If, however, AKI is truly associated with long-term morbidity and mortality, then post-AKI care of these patients should involve closer vigilance and more aggressive treatments in order to improve long-term outcomes. My hope is to obtain R01 grants in the future with the goal of improving risk- stratification of AKI and I also hope to participate in multi-center trials of therapies for AKI and its associated complications. PUBLIC HEALTH RELEVANCE: The relationship between acute kidney injury and long-term outcomes remains unclear. These studies will attempt to determine the association between both traditional kidney exposure variables (e.g., acute change in serum creatinine) and novel kidney exposure variables (e.g., urinary biomarkers) and long-term kidney and mortality outcomes in a cohort of cardiac surgery patients.