Utility of suPAR and NGAL for AKi risk stratification and early optimization of renal risk medications among older patients in the emergency department

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Diagnosis of acute kidney injury (AKI) based on plasma creatinine often lags behind actual changes in renal function. Here, we investigated early detection of AKI using the plasma soluble urokinase plasminogen activator receptor (suPAR) and neutrophil gelatinase‐sssociated lipocalin (NGAL) and observed the impact of early detection on prescribing recommendations for renally‐eliminated medications. This study is a secondary analysis of data from the DISABLMENT cohort on acutely admitted older (≥65 years) medical patients (n = 339). Presence of AKI according to kidney disease: improving global outcomes (KDIGO) criteria was identified from inclusion to 48 h after inclusion. Discriminatory power of suPAR and NGAL was determined by receiver‐operating characteristic (ROC). Selected medications that are contraindicated in AKI were identified in Renbase®. A total of 33 (9.7%) patients developed AKI. Discriminatory power for suPAR and NGAL was 0.69 and 0.78, respectively, at a cutoff of 4.26 ng/mL and 139.5 ng/mL, respectively. The interaction of suPAR and NGAL yielded a discriminatory power of 0.80, which was significantly higher than for suPAR alone (p = 0.0059). Among patients with AKI, 22 (60.6%) used at least one medication that should be avoided in AKI. Overall, suPAR and NGAL levels were independently associated with incident AKI and their combination yielded excellent discriminatory power for risk determination of AKI.

OriginalsprogEngelsk
Artikelnummer843
TidsskriftPharmaceuticals
Vol/bind14
Udgave nummer9
Antal sider15
ISSN1424-8247
DOI
StatusUdgivet - 2021

Bibliografisk note

Funding Information:
Funding: The DISABLEMENT cohort was supported by The Danish Association of Physical Medicine and two grants from The Lundbeck Foundation: J. nr. FP 40/2012 and J. nr. FP 11/2013. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

Funding Information:
The DISABLEMENT cohort was supported by The Danish Association of Physical Medicine and two grants from The Lundbeck Foundation: J. nr. FP 40/2012 and J. nr. FP 11/2013. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

Publisher Copyright:
© 2021 by the authors. Licensee MDPI, Basel, Switzerland.

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