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Angiopoietins as Prognostic Markers for Future Kidney Disease and Heart Failure Events after Acute Kidney Injury

Sherry G Mansour1,2, Pavan K Bhatraju3,4, Steven G Coca5

  • 1Clinical Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut.

Journal of the American Society of Nephrology : JASN
|January 12, 2022
PubMed

Insights

A higher angiopoietin-1 to angiopoietin-2 ratio indicates better vessel stability, significantly reducing risks of chronic kidney disease progression, heart failure, and mortality after acute kidney injury.

Area of Science:

  • Nephrology
  • Cardiology
  • Vascular Biology

Background:

  • Long-term consequences of acute kidney injury (AKI) are not fully understood.
  • Vessel instability, a result of endothelial injury, may be a common factor in chronic kidney disease (CKD) and heart failure development.
  • Angiopoietins are key regulators of vascular homeostasis.

Purpose of the Study:

  • To determine if plasma angiopoietin levels correlate with CKD progression and heart failure admissions post-hospitalization.
  • To investigate the association between the angiopoietin-1 (Angpt-1) to angiopoietin-2 (Angpt-2) ratio and adverse outcomes in patients with and without AKI.
  • To analyze the prognostic value of the Angpt-1:Angpt-2 balance in predicting CKD progression, heart failure, and mortality.

Main Methods:

  • Prospective cohort study of 1503 hospitalized patients.
  • Measurement of plasma angiopoietins (Angpt-1 and Angpt-2) three months post-discharge.
  • Evaluation of associations between the Angpt-1:Angpt-2 ratio and outcomes including CKD progression, heart failure, and all-cause mortality.

Main Results:

  • The highest quartile of the Angpt-1:Angpt-2 ratio was linked to a 72% lower risk of CKD progression and 94% lower risk of heart failure in AKI patients.
  • Among AKI patients, a higher Angpt-1:Angpt-2 ratio was associated with an 82% reduction in mortality.
  • In patients without AKI, the highest Angpt-1:Angpt-2 ratio correlated with significantly lower risks of heart failure and mortality, but not CKD progression.

Conclusions:

  • A higher angiopoietin-1 to angiopoietin-2 ratio is a strong predictor of reduced CKD progression, heart failure, and mortality, particularly in patients with a history of AKI.
  • Vascular homeostasis, as indicated by the Angpt-1:Angpt-2 balance, plays a crucial role in long-term outcomes after AKI.
  • The Angpt-1:Angpt-2 ratio holds potential as a biomarker for assessing cardiovascular and renal risk post-hospitalization.
Abstract

Keywords:
acute kidney injuryangiopoietin-1angiopoietin-2chronic kidney diseaseheart failuremortality

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