Proenkephalin for the early detection of acute kidney injury in hospitalized patients with chronic kidney disease

Tobias Breidthardt, Cedric Jaeger, Andreas Christ, Theresia Klima, Tamina Mosimann, Raphael Twerenbold, Jasper Boeddinghaus, Thomas Nestelberger, Patrick Badertscher, Joachim Struck, Andreas Bergmann, Oliver Hartmann, Stefan Kalbermatter, Giancarlo Marenzi, Christian Mueller

Research output: Contribution to journalArticle

Abstract

Background: The early detection of acute kidney injury (AKI) in patients with chronic kidney disease (CKD) is an unmet clinical need. Proenkephalin (PENK) might improve the early detection of AKI. Methods: One hundred and eleven hospitalized CKD patients undergoing radiographic contrast procedures were enrolled. PENK was measured in a blinded fashion at baseline (before contrast media administration) and on day 1 (after contrast media administration). The potential of PENK levels to predict contrast-induced AKI was the primary endpoint. Results: Baseline creatinine and baseline PENK were similar in AKI and no-AKI patients. In AKI patients, day 1 PENK (198 pmol/L vs 121 pmol/L, P < 0.01) was significantly higher compared to no-AKI patients. The area under the curve (AUC) for the prediction of AKI by day 1 PENK was 0.79, 95% CI: 0.70-0.87, similar to serum creatinine: 0.78, 95% CI: 0.61-0.95. Delta PENK was significantly higher in AKI compared to no-AKI patients (53 pmol/L vs 1 pmol/L, P < 0.01). The AUC for the prediction of AKI by delta PENK was high (0.92, 95%CI 0.82-1.00) and remained high for creatinine-blind AKI (0.94, 95% CI: 0.87-0.97). Conclusion: Delta PENK levels improve the early detection of contrast-induced AKI in CKD patients over serial creatinine sampling. Delta PENK accelerates the detection of creatinine-blind AKI by 24 hours.

Original languageEnglish
Article numbere12999
JournalEuropean Journal of Clinical Investigation
Volume48
Issue number10
DOIs
Publication statusPublished - Oct 1 2018

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Keywords

  • acute kidney injury
  • chronic kidney disease
  • early detection
  • proenkephalin
  • sensitivity
  • specificity

ASJC Scopus subject areas

  • Biochemistry
  • Clinical Biochemistry

Cite this

Breidthardt, T., Jaeger, C., Christ, A., Klima, T., Mosimann, T., Twerenbold, R., Boeddinghaus, J., Nestelberger, T., Badertscher, P., Struck, J., Bergmann, A., Hartmann, O., Kalbermatter, S., Marenzi, G., & Mueller, C. (2018). Proenkephalin for the early detection of acute kidney injury in hospitalized patients with chronic kidney disease. European Journal of Clinical Investigation, 48(10), [e12999]. https://doi.org/10.1111/eci.12999