Author/Editor		Jerin, Aleš; Mosa Fathy, Osama; Kališnik, Jurij-Matija; Žibert, Janez; Skitek, Milan
Title		Serum Klotho as a marker for early diagnosis of acute kidney injury after cardiac surgery
Type		članek
Vol. and No.		, št. Vol. 39
Publication year		2020
Volume		str. 133-139
ISSN		1452-8258 - Journal of Medical Biochemistry
Language		eng
Abstract		Background: Early diagnosis of acute kidney injury (AKI) after cardiac surgery is based on serum creatinine which is neither a specific nor a sensitive biomarker. In our study, we investigated the role of serum Klotho in early prediction of AKI after cardiac surgery using cardiopulmonary bypass (CPB). Methods: The included patients were classified into three groups according to AKI stages using KDIGO criteria. The measurements of creatinine and Klotho levels in serum were performed before surgery, at the end of CPB, 2 hours after the end of CPB, 24 hours and 48 hours postoperatively. Results: Seventy-eight patients were included in the study. A significant increase of creatinine levels (p<0.001) was measured on the first day after the surgery in both AKI groups compared to the non-AKI group. However, a significant difference between AKI-2 and AKI-1 groups (p=0.006) was not measured until the second day after the operation. Using decision trees for classification of patients with a higher or lower risk of AKI we found out that Klotho discriminated between the patients at low risk of developing more severe kidney injury in the first hours after surgery and the patients at high risk better than creatinine. Adding also the early measurements of creatinine in the decision tree model further improved the prediction of AKI. Conclusions: Serum Klotho may be useful to discriminate between the patients at lower and the patients at higher risk of developing severe kidney injury after cardiac surgery using CPB already in the first hours after surgery.Uvod: Rana dijagnoza akutnog oštećenja bubrega (AKI) posle operacije srca se zasniva na kreatininu u serumu koji nije ni specifičan ni osetljiv biomarker. U našoj studiji, istraživali smo ulogu serumskog Klotho-a u ranom predvi|anju AKI nakon operacije srca koristeći kardiopulmonarni bajpas (CPB). Metode: Uključeni pacijenti su klasifikovani u tri grupe u skladu sa AKI fazama po KDIGO kriterijumu. Merenje kreatinina i Klotho-a u serumu je bilo izvedeno pre operacije, krajem CPB, dva sata nakon završetka CPB, 24 sati i 48 sati postoperativno. Rezultati: U studiju je uključeno sedamdeset osam pacijenata. Povišenje nivoa kreatinina prvi dan posle operacije je bilo značajno (p < 0,001) u obe AKI grupe u pore|enju sa non-AKI grupom, a značajna razlika izme|u grupa AKI-2 i AKI-1 (p = 0,006) bila je izmerena tek drugi dan posle operacije. Upotreba stabla odlučivanja za klasifikaciju pacijenata sa manjim i sa ve}im rizikom od razvijanja oštećenja bubrega pokazala je da je Klotho u prvim satima nakon operacije bolji od kreatinina u diferencijaciji između pacijenata sa manjim i pacijenata sa većim rizikom od oštećenja bubrega. Predviđanje razvoja težeg oštećenja bubrega bilo je još bolje sa dodatnim uključivanjem ranih rezultata kreatinina u model. Zaključak: Serumski Klotho može biti koristan za diferencijaciju izme|u pacijenata sa manjim i pacijenata sa većim rizikom od razvijanja težeg oštećenja bubrega posle operacije srca koristeći CPB već u prvim satima nakon operacije.
Descriptors		Holesterol Ateroskleroza
Keywords		akutne poškodbe ledvic operacija srca kreatinin Klotho