• John R Prowle, Vaughn Ostland, Paolo Calzavacca, Elisa Licari, E Valentina Ligabo, Jorge E Echeverri, Sean M Bagshaw, Anja Haase-Fielitz, Michael Haase, Mark Westerman, and Rinaldo Bellomo.
• Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia.
• Nephrol. Dial. Transplant. 2012 Feb 1;27(2):595-602.

BackgroundAcute kidney injury (AKI) is a common and serious complication of cardiopulmonary bypass (CPB) surgery. Hepcidin, a peptide hormone that regulates iron homeostasis, is a potential biomarker of AKI following CPB.MethodsWe investigated the association between post-operative changes in serum and urinary hepcidin and AKI in 93 patients undergoing CPB.ResultsTwenty-five patients developed AKI based on the Risk, Injury, Failure, Loss, End-stage kidney disease (RIFLE) criteria in the first 5 days. Serum hepcidin, urine hepcidin concentration, the urinary hepcidin:creatinine ratio and fractional excretion of hepcidin in urine rose significantly after surgery. However, urine hepcidin concentration and urinary hepcidin:creatinine ratio were significantly lower at 24 h in patients with RIFLE-Risk, Injury or Failure compared to those without AKI (P = 0.0009 and P < 0.0001, respectively). Receiver operator characteristic analysis showed that lower 24-h urine hepcidin concentration and urinary hepcidin:creatinine ratio were sensitive and specific predictors of AKI. The urinary hepcidin:creatinine ratio had an area under the curve for the diagnosis of RIFLE ≥ risk at 24 h of 0.77 and of 0.84 for RIFLE ≥ injury. Urinary hepcidin had similar predictive accuracy. Such predictive ability remained when patients with early creatinine increases were excluded.ConclusionsUrinary hepcidin and hepcidin:creatinine ratio are biomarkers of AKI after CPB, with an inverse association between its increase at 24 h and risk of AKI in the first five post-operative days. Measuring hepcidin in the urine on the first day following surgery may deliver earlier diagnosis and interventions.

49 keywords...

hide…