The Association Between Urine TIMP-2*IGFBP7 and Successful Discontinuation of Renal Replacement Therapy in Patients with Acute Kidney Injury: A Prospective Observational Study
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Abstract
Background: Currently, there are no recommendations in terms of timing for discontinuation of intermittent kidney replacement therapy (IKRT) in acute kidney injury (AKI). Cell cycle arrest biomarkers including urine tissue inhibitor of metalloproteinase-2 (TIMP2) and urine insulin-like growth factor binding protein-7 (IGFBP7) have been shown to have good performance in predicting AKI in different groups of patients. Recent evidence also suggests the ability of urine cell cycle arrest biomarkers in predicting renal recovery. The present study evaluated the association between urine TIMP2*IGFBP7 levels and successful discontinuation of intermittent hemodialysis in patients with AKI.
Methods: We prospectively enrolled medical and surgical patients who were diagnosed with AKI based on KDIGO 2012 criteria and required intermittent hemodialysis from July 2021 to January 2022. Urine volume, serum creatinine, and urine TIMP2*IGFBP7 were measured before every session of hemodialysis that was likely to be the last session. The primary outcome was the successful discontinuation of IKRT for 14 days.
Results: Thirty-nine sessions of hemodialysis from 17 patients were included. Successful termination of IKRT for 14 days followed 8 (20.51%) of the 39 sessions. There was no association between urine TIMP2*IGFBP7 and the outcome with the area under the receiver operating characteristic curve (AUC) of 0.55 [95% confidential interval (CI) 0.32-0.77, P=0.66]. On the other hand, 24-hour urine volume prior to hemodialysis session had a fair performance in predicting successful discontinuation of IKRT with the AUC of 0.76 [95% CI 0.56-0.96, P=0.023]. The optimal cut-point of urine volume was >1,478 ml/day (Youden’s index 0.49)
Conclusion: There was no association between urine TIMP2*IGFBP7 levels and successful discontinuation of IKRT in patients with AKI. 24-hour urine volume prior to hemodialysis session showed a fair predictive performance of renal recovery.
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