Acute kidney injury (AKI) is common after cardiac surgery and impacts short and long-term mortality. The parent grant, RO1 (HL-085757), focused on developing novel tools for assessment of structural kidney damage and comparing new tests to the traditional measurement of serum creatinine, which is a measure of kidney filtration. We created the Translational Research Investigating Biomarker Endpoints (TRIBE) consortium and fulfilled the goals of all of the specific aims of the grant and reported results on several novel urine and plasma biomarkers of kidney injury, such as urine IL-18, urine and plasma NGAL, urine albumin, plasma BNP, and plasma cystatin C. We prospectively enrolled over 2000 adults and children undergoing cardiac surgery at 9 centers and developed a robust sample biorepository linked to clinical variables. In this competitive renewal, we will enrich our cohort y gathering information on long-term outcomes in adult and pediatric patients through continued phone calls, in-person visits, and linkages of the TRIBE cohort to national administrative databases. We will also perform measures of three promising urine biomarkers (KIM- 1, L-FABP and urine cystatin C) and two plasma biomarkers (CK-MB, high sensitivity troponin-T) on the samples stored in our biorepository. With a total of 11 measured biomarkers (from the parent and renewal grants), we will create multi-marker panels for predicting AKI and other outcomes using emerging and innovative statistical methods. We hypothesize that the pre-operative and post-operative biomarkers will not only predict AKI, but also will predict longer-term complications years later, such as chronic kidney disease, end-stage renal disease, and death. Additionally, we hypothesize those patients with high biomarker levels, but no evidence of clinical AKI (subclinical AKI);will also have poor long-term outcomes. The availability of reliabl clinical models for these short and long-term outcomes will assist with informed decision making, adequate planning for surgeons, post-discharge management, and inform future clinical trials. Our primary research aims are:
Aim 1 : To ascertain long-term outcomes associated with AKI after cardiac surgery in adults and children.
Aim 2 : To construct a multi-marker biomarker panel to improve risk prediction of outcomes in adults and children.

Public Health Relevance

Acute Kidney Injury (AKI), is common complication in adults and children undergoing cardiac surgery. AKI has enormous impact on morbidity, mortality and resource utilization. In this proposal, we evaluate novel urinary biomarkers and their relationship to mortality, decline in kidney function and clinical outcomes. We plan to develop a novel panel of biomarkers to predict AKI and its sequelae;a potential method for the early detection of kidney injury and ultimately the development of therapies to reduce the burden of AKI.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
5R01HL085757-07
Application #
8458526
Study Section
Special Emphasis Panel (ZRG1-DKUS-A (05))
Program Officer
Miller, Marissa A
Project Start
2007-05-01
Project End
2016-03-31
Budget Start
2013-04-01
Budget End
2014-03-31
Support Year
7
Fiscal Year
2013
Total Cost
$726,262
Indirect Cost
$208,891
Name
Yale University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
043207562
City
New Haven
State
CT
Country
United States
Zip Code
06520
Kerr, Kathleen F; Wang, Zheyu; Janes, Holly et al. (2014) Net reclassification indices for evaluating risk prediction instruments: a critical review. Epidemiology 25:114-21
Belcher, Justin M; Sanyal, Arun J; Peixoto, Aldo J et al. (2014) Kidney biomarkers and differential diagnosis of patients with cirrhosis and acute kidney injury. Hepatology 60:622-32
Greenberg, Jason H; Coca, Steven; Parikh, Chirag R (2014) Long-term risk of chronic kidney disease and mortality in children after acute kidney injury: a systematic review. BMC Nephrol 15:184
Khan, Usman A; Coca, Steven G; Hong, Kwangik et al. (2014) Blood transfusions are associated with urinary biomarkers of kidney injury in cardiac surgery. J Thorac Cardiovasc Surg 148:726-32
Parikh, Chirag R; Thiessen-Philbrook, Heather (2014) Key concepts and limitations of statistical methods for evaluating biomarkers of kidney disease. J Am Soc Nephrol 25:1621-9
Hornik, Christoph P; Krawczeski, Catherine D; Zappitelli, Michael et al. (2014) Serum brain natriuretic peptide and risk of acute kidney injury after cardiac operations in children. Ann Thorac Surg 97:2142-7
Molnar, Amber O; Parikh, Chirag R; Coca, Steven G et al. (2014) Association between preoperative statin use and acute kidney injury biomarkers in cardiac surgical procedures. Ann Thorac Surg 97:2081-7
Parikh, Chirag R; Butrymowicz, Isabel; Yu, Angela et al. (2014) Urine stability studies for novel biomarkers of acute kidney injury. Am J Kidney Dis 63:567-72
Kerr, Kathleen F; Meisner, Allison; Thiessen-Philbrook, Heather et al. (2014) Developing risk prediction models for kidney injury and assessing incremental value for novel biomarkers. Clin J Am Soc Nephrol 9:1488-96
Brown, Jeremiah R; Parikh, Chirag R; Ross, Cathy S et al. (2014) Impact of perioperative acute kidney injury as a severity index for thirty-day readmission after cardiac surgery. Ann Thorac Surg 97:111-7

Showing the most recent 10 out of 43 publications