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Nephrocheck after cardiac surgery: Does it play a role in daily practice? A sequel of "Nephrocheck results should be
Camilla L'Acqua1, Erminio Sisillo1, Luca Salvi1
1Anesthesia and Intensive Care Unit, Centro Cardiologico Monzino, Milan, Italy.
Insights
Early detection of acute kidney injury after cardiac surgery can be improved. Assessing urine dilution alongside the AKIRisk score enhances the discrimination of acute kidney injury severity in clinical practice.
Area of Science:
- Nephrology
- Cardiovascular Surgery
- Biomarker Detection
Background:
- Acute kidney injury (AKI) is a significant complication following cardiac surgery, impacting patient morbidity and mortality.
- Nephrocheck offers early AKI detection via bedside urinalysis of cell-cycle arrest biomarkers, but its AKIRisk score interpretation is uncertain due to overlapping values.
- Potential dilution of urine samples may contribute to the AKIRisk score's overlap across different RIFLE (Risk, Injury, Failure, Loss, End-stage renal disease) severity groups.
Purpose of the Study:
- To pilot the Nephrocheck test in daily clinical practice for early AKI detection in cardiac surgery patients.
- To investigate the correlation between urine creatinine levels and Nephrocheck scores to identify potential sample dilution.
- To determine if incorporating urine dilution assessment improves AKI severity discrimination.
Main Methods:
- A pilot study involving 68 patients undergoing elective cardiac surgery with specific risk factors (age >70, GFR <60 mL/min, LVEF <41%, redo or combined procedures).
- Bedside urinalysis using Nephrocheck to obtain AKIRisk scores.
- Measurement of urine creatinine to assess sample concentration/dilution.
- Correlation analysis between AKIRisk scores and urine creatinine levels.
Main Results:
- Twenty-five out of 68 patients developed acute kidney injury.
- A correlation was observed where samples with low Nephrocheck scores (<0.2) also exhibited low urine creatinine (<50 mg/dL), indicating potential sample dilution.
- This suggests that low urine creatinine can identify diluted samples that might otherwise lead to misinterpretation of AKI severity.
Conclusions:
- In clinical practice, the AKIRisk score, when combined with an assessment of urine dilution (using urine creatinine), can better differentiate the severity of acute kidney injury post-cardiac surgery.
- This combined approach enhances the reliability of early AKI detection and risk stratification in this patient population.
Abstract:
Acute kidney injury is a well-recognized complication after cardiac surgery and significantly affects morbidity and mortality. Although the mechanisms of acute kidney injury are not fully understood, Nephrocheck (Astute Medical, San Diego, CA, USA) is a meter for early detection of acute kidney injury based on bedside urinalysis of two cell-cycle arrest biomarkers. However, considerable overlap in the AKIRiskTM score of different RIFLE groups makes interpretation of the score uncertain. A possible reason for the overlap in the AKIRisk score between different RIFLE groups could be that the score is not corrected for dilution. We performed a pilot study to explore the applicability of the test in our daily practice. A total of 68 patients electively scheduled for cardiac surgery with at least two of the following inclusion criteria: age > 70 years, glomerular filtration rate <60 mL/min, left ventricular ejection fraction <41%, redo procedure and combined procedures have been enrolled in the study, and 25 of them developed acute kidney injury. We described the correlation between urine creatinine and Nephrocheck, all the samples with low Nephrocheck (<0.2) also have low urine creatinine, less than 50 mg/dL, detecting a potential diluted sample. In conclusion, in our daily practice AKIRisk score, together with an assessment of whether urine is diluted or concentrated can better discriminate between various degrees of acute kidney injury.
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