Evaluation of a Novel Biomarker Panel for Acute Kidney Injury Following Endovascular Aortic Repair

Acute Kidney Injury (AKI) following endovascular aortic repair (EVAR) is often diagnosed too late using conventional markers, limiting opportunities for timely intervention in this high-risk population. We investigated whether a mechanism-based biomarker panel could provide improved early AKI detection in EVAR patients. This prospective, single-center study enrolled 68 consecutive EVAR patients between April 2022 and June 2024. AKI was diagnosed using KDIGO 2012 criteria. Seven novel biomarkers, including Proenkephalin A 119-159 (penKid), Semaphorin-3A (SEMA-3A), Retinol Binding Protein-4 (RBP-4), Kidney Injury Molecule-1 (KIM-1), Netrin-1, Tissue Inhibitor of Metalloproteinases-2, and Insulin-Like Growth Factor Binding Protein-7, were measured at baseline, immediate postoperative, 24 h, and 48 h time points, and selected based on distinct nephron locations and release mechanisms. AKI occurred in 18 (26.5%) patients. Top-performing individual biomarkers included serum SEMA-3A (AUC 0.88), serum RBP-4 (AUC 0.81), and penKid (AUC 0.76). A three-biomarker panel combining serum penKid, serum SEMA-3A, and urinary KIM-1 achieved robust discriminatory performance (AUC 0.89, 95% CI 0.77-1.00), superior to individual biomarkers. An alternative panel with serum RBP-4 demonstrated comparable performance (AUC 0.81, 95% CI 0.65-0.99). Multi-biomarker panels combining functional, stress, and injury markers demonstrate promising performance for early AKI detection in EVAR patients. External validation in independent, multi-center cohorts is required before clinical implementation.