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Urinary Dickkopf-3 and Contrast-Associated Kidney Damage
Giuseppina Roscigno1, Cristina Quintavalle2, Giuseppe Biondi-Zoccai3
1Department of Molecular Medicine and Medical Biotechnology, "Federico II" University, Naples, Italy; Percuros, Leiden, the Netherlands.
Journal of the American College of Cardiology
|May 28, 2021
Summary
Urinary dickkopf-3 (DKK3) effectively predicts kidney injury risk in patients undergoing cardiovascular procedures. This biomarker improves risk assessment for contrast-associated acute kidney injury and persistent kidney dysfunction.
Area of Science:
- Nephrology
- Cardiology
- Biomarker Discovery
Background:
- Administration of iodinated contrast media (CM) during cardiovascular procedures can impair kidney function.
- Contrast-associated acute kidney injury (CA-AKI) is a significant concern in patients undergoing these interventions.
Purpose of the Study:
- To evaluate urinary dickkopf-3 (DKK3) as a predictive biomarker for CA-AKI and persistent kidney dysfunction.
- To assess the added value of urinary DKK3/creatinine ratio (uDKK3/uCr) in existing risk prediction models.
Main Methods:
- 458 patients with chronic kidney disease undergoing procedures with CM received nephroprotective interventions.
- Urinary DKK3/creatinine ratio (uDKK3/uCr), urine and serum neutrophil gelatinase-associated lipocalin (uNGAL, sNGAL), and serum cystatin C (sCyC) were measured.
- CA-AKI and persistent kidney dysfunction were defined based on serum creatinine and estimated glomerular filtration rate changes.
Main Results:
- CA-AKI occurred in 14% of patients; baseline uDKK3/uCr ≥491 pg/mg was the optimal threshold for prediction.
- Persistent kidney dysfunction occurred in 12% of patients; baseline uDKK3/uCr ≥322 pg/mg was the optimal threshold.
- Adding baseline uDKK3/uCr significantly improved the accuracy of established risk scores (Mehran, Gurm, NCDR) for predicting both outcomes.
Conclusions:
- Baseline urinary DKK3/creatinine ratio is a reliable and valuable biomarker for identifying patients at risk of kidney dysfunction after cardiovascular procedures.
- Incorporating uDKK3/uCr into risk prediction models enhances the identification of patients susceptible to CA-AKI and persistent kidney dysfunction.
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