Time To Think of Novel Biomarkers to Detect Perioperative Acute Kidney Injury in Surgical Patients

Singh, Sanjeev; Okyere, Isaac; Singh, Arti; Shaifulla, Pavagada; Okyere, Perditer; Boamah, Richmond Adu Boahen

doi:10.21608/eajbsc.2022.226918

Time To Think of Novel Biomarkers to Detect Perioperative Acute Kidney Injury in Surgical Patients

Document Type : Original Article

Authors

¹ School of Medicine and Dentistry, CHS, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana -Directorate of Anaesthesia and Intensive Care, Komfo Anokye Teaching Hospital, Kumasi, Ghana

² School of Medicine and Dentistry, CHS, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana

³ School of Public health, CHS, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana

⁴ Department of Medicine, Viswabhatathi Medical College, Kurnool, India

10.21608/eajbsc.2022.226918

Abstract

Background: Perioperative (peri-op) acute kidney injury is impairment of normal baseline renal function during surgery or the immediate postoperative (post-op) period. This study evaluated the incidence of renal tubular damage, severity, and duration of the peri-op period using old and novel biomarkers. Methods: This prospective, randomised, and double-blinded clinical study involved 69 patients. Blood and urine samples were collected before and after anaesthesia, and serum creatinine (SCr), cystatin C (SCysC), and urinary N-Acetyl- β-D- glucosaminidase (uNAG) were assayed simultaneously with urea, uric acid, and electrolytes to detect renal tubular damage. Kidney Disease Improving Global Outcomes (KDIGO)-SCr and Translational Research in Biomarker Endpoint (TRIBE) – ScysC criteria used to define AKI. Results: The pre-to post-op alterations between SCr (73.50 (62.0-89.50) vs 72.50 (59.25-83.75), p=0.166) and SCysC (51.69 (47.50-62.90) vs 54.84 (51.70-61.82), p=0.100), and the incidence of AKI by KDIGO and TRIBE was 9.4% and 18.8%, respectively. Patients with AKI by KDIGO were all female whereas, for TRIBE, 17.2% females and 1.6% males. The Kaplan-Meier survival curve analysis for AKI based on KDIGO stratified by sex showed that at 63- and 172-minutes post-general anaesthesia (GA), the survival rate against AKI was 97.8% (95% CI: 93.7-100%) and 22.6% (77.4%; 95% CI: 60.5-99.1%) for females and on the contrary no incidence of AKI in male. With TRIBE at 58 minutes post-GA, the survival rate of males was 85.7% (95% CI: 63.3-100.0%) and females at 40 minutes, 72 minutes and 180 minutes were 98.2% (95% CI: 94.8-100.0%), 89.5% (95% CI: 81.1-98.7%) and 52.6% (95% CI: 32.9-84.0%), respectively. Conclusions: AKI was common among female adult general surgical patients undergoing GA. SCysC is a more sensitive marker in detecting AKI than SCr in adult general surgical patients.

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