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Plasma kidney injury molecule‐1 in heart failure: renal mechanisms and clinical outcome
Author(s) -
Emmens Johanna E.,
ter Maaten Jozine M.,
Matsue Yuya,
Metra Marco,
O'Connor Christopher M.,
Ponikowski Piotr,
Teerlink John R.,
Cotter Gad,
Davison Beth,
Cleland John G.,
Givertz Michael M.,
Bloomfield Daniel M.,
Dittrich Howard C.,
Todd John,
van Veldhuisen Dirk J.,
Hillege Hans L.,
Damman Kevin,
van der Meer Peter,
Voors Adriaan A.
Publication year - 2016
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.426
Subject(s) - medicine , renal function , hazard ratio , creatinine , acute kidney injury , cystatin c , heart failure , urology , urinary system , endocrinology , confidence interval , cardiology , gastroenterology
Aims Urinary kidney injury molecule‐1 ( KIM ‐1) is a marker of tubular damage and associated with worse outcome in heart failure ( HF ). Plasma KIM ‐1 has not been described in HF . Methods and results In a renal mechanistic cohort of 120 chronic HF patients, we established the association between plasma KIM ‐1, renal invasive haemodynamic parameters {renal blood flow ([ 131 I ]hippuran clearance) and measured glomerular filtration rate ( GFR ; [ 125 I ]iothalamate)} and urinary tubular damage markers. The association between plasma KIM ‐1, plasma creatinine, and clinical outcome was further explored in a cohort of 2033 acute HF patients. Median plasma KIM ‐1 was 171.5 pg/ mL (122.8–325.7) in chronic ( n = 99) and 295.1 pg/ mL (182.2–484.2) in acute HF ( n = 1588). In chronic HF , plasma KIM ‐1 was associated with GFR ( P < 0.001), creatinine, and cystatin C. Plasma KIM ‐1 was associated with urinary N ‐acetyl‐β‐ d ‐glucosaminidase ( NAG ), but not with other urinary tubular damage markers. Log plasma KIM ‐1 predicted adverse clinical outcome after adjustment for age, gender, and GFR [hazard ratio ( HR ) 1.94, 95% confidence interval ( CI ) 1.07–3.53, P = 0.030]. Statistical significance was lost after correction for NT‐proBNP ( HR 1.61, 95% CI 0.81–3.20, P = 0.175). In acute HF , higher plasma KIM ‐1 levels were associated with higher creatinine, lower albumin, and presence of diabetes. Log plasma KIM ‐1 predicted 60‐day HF rehospitalization ( HR 1.27, 95% CI 1.03–1.55, P = 0.024), but not 180‐day mortality or 60‐day death or renal or cardiovascular rehospitalization. Conclusions Plasma KIM ‐1 is associated with glomerular filtration and urinary NAG , but not with other urinary tubular damage markers. Plasma KIM ‐1 does not predict outcome in chronic HF after correction for NT‐proBNP . In acute HF , plasma KIM ‐1 predicts HF rehospitalization in multivariable analysis.