High preoperative plasma endothelin-1 levels are associated with increased acute kidney injury risk after pulmonary endarterectomy

Fabrizio Grosjean, Mara De Amici, Catherine Klersy, Gianluca Marchi, Antonio Sciortino, Federica Spaltini, Maurizio Pin, Valentina Grazioli, Anna Celentano, Benedetta Vanini, Giorgia Testa, Vincenzo Sepe, Teresa Rampino, Andrea Maria D’Armini

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objectives: The only curative treatment for chronic thromboembolic pulmonary hypertension (CTEPH) is pulmonary endarterectomy (PEA). PEA requires cardiopulmonary bypass (CPB) which is associated with a high acute kidney injury (AKI) risk. Circulating endothelin-1 (ET-1) levels are elevated in CTEPH, and ET-1 plays a pivotal role in AKI. Because AKI is burdened by high morbidity and mortality, we aimed to evaluate the association between preoperative ET-1 and the risk to develop AKI in CTEPH individuals who undergo PEA. We also evaluated the association of AKI and ET-1 with kidney function and mortality at 1 year after PEA. Methods: In 385 consecutive patients diagnosed with CTEPH who underwent PEA at the Foundation IRCC Policlinico San Matteo (Pavia, Italy) from January 2009 to April 2015, we assessed preoperative circulating ET-1 by ELISA and identified presence of AKI based on 2012 KDIGO criteria. Results: AKI occurred in 26.5% of the 347 patients included in the analysis, and was independently associated with preoperative ET-1 (p = 0.008), body mass index (BMI) (p = 0.022), male gender (p = 0.005) and duration of CPB (p = 0.002). At 1-year post PEA, estimated glomerular filtration rate (eGFR) significantly improved in patients who did not develop AKI [ΔeGFR 5.6 ml/min/1.73 m2 (95% CI 3.6–7.6), p < 0.001] but not in those with perioperative AKI. AKI (p < 0.001), age (p < 0.001), preoperative eGFR (p < 0.001) and systemic hypertension diagnosis (p = 0.015) were independently associated with 1-year ΔeGFR. Neither perioperative AKI nor preoperative ET-1 was associated with 1-year survival. Conclusion: Perioperative AKI is associated with higher preoperative circulating ET-1 and it negatively influences long-term kidney function in patients with CTEPH who undergo PEA.

Original languageEnglish
JournalJournal of Nephrology
DOIs
Publication statusAccepted/In press - Jan 1 2018

Fingerprint

Endarterectomy
Endothelin-1
Acute Kidney Injury
Lung
Pulmonary Hypertension
Glomerular Filtration Rate
Cardiopulmonary Bypass
Kidney
Mortality
Italy
Body Mass Index
Enzyme-Linked Immunosorbent Assay

Keywords

  • Acute kidney failure
  • Cardiopulmonary bypass
  • Chronic thromboembolic pulmonary hypertension
  • ET-1

ASJC Scopus subject areas

  • Nephrology

Cite this

High preoperative plasma endothelin-1 levels are associated with increased acute kidney injury risk after pulmonary endarterectomy. / Grosjean, Fabrizio; De Amici, Mara; Klersy, Catherine; Marchi, Gianluca; Sciortino, Antonio; Spaltini, Federica; Pin, Maurizio; Grazioli, Valentina; Celentano, Anna; Vanini, Benedetta; Testa, Giorgia; Sepe, Vincenzo; Rampino, Teresa; D’Armini, Andrea Maria.

In: Journal of Nephrology, 01.01.2018.

Research output: Contribution to journalArticle

Grosjean, Fabrizio ; De Amici, Mara ; Klersy, Catherine ; Marchi, Gianluca ; Sciortino, Antonio ; Spaltini, Federica ; Pin, Maurizio ; Grazioli, Valentina ; Celentano, Anna ; Vanini, Benedetta ; Testa, Giorgia ; Sepe, Vincenzo ; Rampino, Teresa ; D’Armini, Andrea Maria. / High preoperative plasma endothelin-1 levels are associated with increased acute kidney injury risk after pulmonary endarterectomy. In: Journal of Nephrology. 2018.
@article{0dfd69a97e7f45888e2ec59894fd61ae,
title = "High preoperative plasma endothelin-1 levels are associated with increased acute kidney injury risk after pulmonary endarterectomy",
abstract = "Objectives: The only curative treatment for chronic thromboembolic pulmonary hypertension (CTEPH) is pulmonary endarterectomy (PEA). PEA requires cardiopulmonary bypass (CPB) which is associated with a high acute kidney injury (AKI) risk. Circulating endothelin-1 (ET-1) levels are elevated in CTEPH, and ET-1 plays a pivotal role in AKI. Because AKI is burdened by high morbidity and mortality, we aimed to evaluate the association between preoperative ET-1 and the risk to develop AKI in CTEPH individuals who undergo PEA. We also evaluated the association of AKI and ET-1 with kidney function and mortality at 1 year after PEA. Methods: In 385 consecutive patients diagnosed with CTEPH who underwent PEA at the Foundation IRCC Policlinico San Matteo (Pavia, Italy) from January 2009 to April 2015, we assessed preoperative circulating ET-1 by ELISA and identified presence of AKI based on 2012 KDIGO criteria. Results: AKI occurred in 26.5{\%} of the 347 patients included in the analysis, and was independently associated with preoperative ET-1 (p = 0.008), body mass index (BMI) (p = 0.022), male gender (p = 0.005) and duration of CPB (p = 0.002). At 1-year post PEA, estimated glomerular filtration rate (eGFR) significantly improved in patients who did not develop AKI [ΔeGFR 5.6 ml/min/1.73 m2 (95{\%} CI 3.6–7.6), p < 0.001] but not in those with perioperative AKI. AKI (p < 0.001), age (p < 0.001), preoperative eGFR (p < 0.001) and systemic hypertension diagnosis (p = 0.015) were independently associated with 1-year ΔeGFR. Neither perioperative AKI nor preoperative ET-1 was associated with 1-year survival. Conclusion: Perioperative AKI is associated with higher preoperative circulating ET-1 and it negatively influences long-term kidney function in patients with CTEPH who undergo PEA.",
keywords = "Acute kidney failure, Cardiopulmonary bypass, Chronic thromboembolic pulmonary hypertension, ET-1",
author = "Fabrizio Grosjean and {De Amici}, Mara and Catherine Klersy and Gianluca Marchi and Antonio Sciortino and Federica Spaltini and Maurizio Pin and Valentina Grazioli and Anna Celentano and Benedetta Vanini and Giorgia Testa and Vincenzo Sepe and Teresa Rampino and D’Armini, {Andrea Maria}",
year = "2018",
month = "1",
day = "1",
doi = "10.1007/s40620-018-0538-7",
language = "English",
journal = "Journal of Nephrology",
issn = "1121-8428",
publisher = "Springer International Publishing",

}

TY - JOUR

T1 - High preoperative plasma endothelin-1 levels are associated with increased acute kidney injury risk after pulmonary endarterectomy

AU - Grosjean, Fabrizio

AU - De Amici, Mara

AU - Klersy, Catherine

AU - Marchi, Gianluca

AU - Sciortino, Antonio

AU - Spaltini, Federica

AU - Pin, Maurizio

AU - Grazioli, Valentina

AU - Celentano, Anna

AU - Vanini, Benedetta

AU - Testa, Giorgia

AU - Sepe, Vincenzo

AU - Rampino, Teresa

AU - D’Armini, Andrea Maria

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objectives: The only curative treatment for chronic thromboembolic pulmonary hypertension (CTEPH) is pulmonary endarterectomy (PEA). PEA requires cardiopulmonary bypass (CPB) which is associated with a high acute kidney injury (AKI) risk. Circulating endothelin-1 (ET-1) levels are elevated in CTEPH, and ET-1 plays a pivotal role in AKI. Because AKI is burdened by high morbidity and mortality, we aimed to evaluate the association between preoperative ET-1 and the risk to develop AKI in CTEPH individuals who undergo PEA. We also evaluated the association of AKI and ET-1 with kidney function and mortality at 1 year after PEA. Methods: In 385 consecutive patients diagnosed with CTEPH who underwent PEA at the Foundation IRCC Policlinico San Matteo (Pavia, Italy) from January 2009 to April 2015, we assessed preoperative circulating ET-1 by ELISA and identified presence of AKI based on 2012 KDIGO criteria. Results: AKI occurred in 26.5% of the 347 patients included in the analysis, and was independently associated with preoperative ET-1 (p = 0.008), body mass index (BMI) (p = 0.022), male gender (p = 0.005) and duration of CPB (p = 0.002). At 1-year post PEA, estimated glomerular filtration rate (eGFR) significantly improved in patients who did not develop AKI [ΔeGFR 5.6 ml/min/1.73 m2 (95% CI 3.6–7.6), p < 0.001] but not in those with perioperative AKI. AKI (p < 0.001), age (p < 0.001), preoperative eGFR (p < 0.001) and systemic hypertension diagnosis (p = 0.015) were independently associated with 1-year ΔeGFR. Neither perioperative AKI nor preoperative ET-1 was associated with 1-year survival. Conclusion: Perioperative AKI is associated with higher preoperative circulating ET-1 and it negatively influences long-term kidney function in patients with CTEPH who undergo PEA.

AB - Objectives: The only curative treatment for chronic thromboembolic pulmonary hypertension (CTEPH) is pulmonary endarterectomy (PEA). PEA requires cardiopulmonary bypass (CPB) which is associated with a high acute kidney injury (AKI) risk. Circulating endothelin-1 (ET-1) levels are elevated in CTEPH, and ET-1 plays a pivotal role in AKI. Because AKI is burdened by high morbidity and mortality, we aimed to evaluate the association between preoperative ET-1 and the risk to develop AKI in CTEPH individuals who undergo PEA. We also evaluated the association of AKI and ET-1 with kidney function and mortality at 1 year after PEA. Methods: In 385 consecutive patients diagnosed with CTEPH who underwent PEA at the Foundation IRCC Policlinico San Matteo (Pavia, Italy) from January 2009 to April 2015, we assessed preoperative circulating ET-1 by ELISA and identified presence of AKI based on 2012 KDIGO criteria. Results: AKI occurred in 26.5% of the 347 patients included in the analysis, and was independently associated with preoperative ET-1 (p = 0.008), body mass index (BMI) (p = 0.022), male gender (p = 0.005) and duration of CPB (p = 0.002). At 1-year post PEA, estimated glomerular filtration rate (eGFR) significantly improved in patients who did not develop AKI [ΔeGFR 5.6 ml/min/1.73 m2 (95% CI 3.6–7.6), p < 0.001] but not in those with perioperative AKI. AKI (p < 0.001), age (p < 0.001), preoperative eGFR (p < 0.001) and systemic hypertension diagnosis (p = 0.015) were independently associated with 1-year ΔeGFR. Neither perioperative AKI nor preoperative ET-1 was associated with 1-year survival. Conclusion: Perioperative AKI is associated with higher preoperative circulating ET-1 and it negatively influences long-term kidney function in patients with CTEPH who undergo PEA.

KW - Acute kidney failure

KW - Cardiopulmonary bypass

KW - Chronic thromboembolic pulmonary hypertension

KW - ET-1

UR - http://www.scopus.com/inward/record.url?scp=85053662819&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85053662819&partnerID=8YFLogxK

U2 - 10.1007/s40620-018-0538-7

DO - 10.1007/s40620-018-0538-7

M3 - Article

AN - SCOPUS:85053662819

JO - Journal of Nephrology

JF - Journal of Nephrology

SN - 1121-8428

ER -