Abstract
Background: Acute cardiorenal syndrome (CRS) is a common clinical condition associated with adverse outcomes. Early identification of acute kidney injury in this setting remains challenging given that serum creatinine level is a marker of renal function and not kidney injury. Summary: Several renal injury-related molecules are now available, which may help elucidate the complexities of the organ crosstalk, enabling more accurate risk stratification and effective interventions. Key Messages: This review highlights the major studies that have characterized the diagnostic and prognostic predictive power of these biomarkers with reference to acute CRS. Although more research is needed, the current results are very promising.
References
1.
Ronco C, Haapio M, House AA, Anavekar N, Bellomo R: Cardiorenal syndrome. J Am Coll Cardiol 2008;52:1527-1539.
2.
Ronco C, Cruz DN, Ronco F: Cardiorenal syndromes. Curr Opin Crit Care 2009;15:384-391.
3.
Ronco C, Cicoira M, McCullough PA: Cardiorenal syndrome type 1: pathophysiological crosstalk leading to combined heart and kidney dysfunction in the setting of acutely decompensated heart failure. J Am Coll Cardiol 2012;60:1031-1042.
4.
Zhou Q, Zhao C, Xie D, Xu D, Bin J, Chen P, Liang M, Zhang X, Hou F: Acute and acute-on-chronic kidney injury of patients with decompensated heart failure: impact on outcomes. BMC Nephrol 2012;13:51.
5.
Cheng H, Chen YP: Clinical prediction scores for type 1 cardiorenal syndrome derived and validated in Chinese cohorts. Cardiorenal Med 2015;5:12-19.
6.
Braunwald E, Bonow RO: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, ed 9. Philadelphia, Saunders, 2012.
7.
Bock JS, Gottlieb SS: Cardiorenal syndrome: new perspectives. Circulation 2010;121:2592-2600.
8.
Testani JM, Coca SG, Shannon RP, Kimmel SE, Cappola TP: Influence of renal dysfunction phenotype on mortality in the setting of cardiac dysfunction: analysis of three randomized controlled trials. Eur J Heart Fail 2011;13:1224-1230.
9.
Smith GL, Lichtman JH, Bracken MB, Shlipak MG, Phillips CO, DiCapua P, Krumholz HM: Renal impairment and outcomes in heart failure: systematic review and meta-analysis. J Am Coll Cardiol 2006;47:1987-1996.
10.
Bouquegneau A, Krzesinski JM, Delanaye P, Cavalier E: Biomarkers and physiopathology in the cardiorenal syndrome. Clin Chim Acta 2015;443:100-107.
11.
Damman K, Van Veldhuisen DJ, Navis G, Vaidya VS, Smilde TD, Westenbrink BD, Bonventre JV, Voors AA, Hillege HL: Tubular damage in chronic systolic heart failure is associated with reduced survival independent of glomerular filtration rate. Heart 2010;96:1297-1302.
12.
Chen HH, Anstrom KJ, Givertz MM, Stevenson LW, Semigran MJ, Goldsmith SR, Bart BA, Bull DA, Stehlik J, LeWinter MM, Konstam MA, Huggins GS, Rouleau JL, O'Meara E, Tang WH, Starling RC, Butler J, Deswal A, Felker GM, O'Connor CM, Bonita RE, Margulies KB, Cappola TP, Ofili EO, Mann DL, Davila-Roman VG, McNulty SE, Borlaug BA, Velazquez EJ, Lee KL, Shah MR, Hernandez AF, Braunwald E, Redfield MM: Low-dose dopamine or low-dose nesiritide in acute heart failure with renal dysfunction: the ROSE acute heart failure randomized trial. JAMA 2013;310:2533-2543.
13.
Massie BM, O'Connor CM, Metra M, Ponikowski P, Teerlink JR, Cotter G, Weatherley BD, Cleland JG, Givertz MM, Voors A, DeLucca P, Mansoor GA, Salerno CM, Bloomfield DM, Dittrich HC: Rolofylline, an adenosine A1-receptor antagonist, in acute heart failure. N Engl J Med 2010;363:1419-1428.
14.
O'Connor CM, Starling RC, Hernandez AF, Armstrong PW, Dickstein K, Hasselblad V, Heizer GM, Komajda M, Massie BM, McMurray JJ, Nieminen MS, Reist CJ, Rouleau JL, Swedberg K, Adams KJ, Anker SD, Atar D, Battler A, Botero R, Bohidar NR, Butler J, Clausell N, Corbalan R, Costanzo MR, Dahlstrom U, Deckelbaum LI, Diaz R, Dunlap ME, Ezekowitz JA, Feldman D, Felker GM, Fonarow GC, Gennevois D, Gottlieb SS, Hill JA, Hollander JE, Howlett JG, Hudson MP, Kociol RD, Krum H, Laucevicius A, Levy WC, Mendez GF, Metra M, Mittal S, Oh BH, Pereira NL, Ponikowski P, Tang WH, Tanomsup S, Teerlink JR, Triposkiadis F, Troughton RW, Voors AA, Whellan DJ, Zannad F, Califf RM: Effect of nesiritide in patients with acute decompensated heart failure. N Engl J Med 2011;365:32-43.
15.
Bart BA, Goldsmith SR, Lee KL, Givertz MM, O'Connor CM, Bull DA, Redfield MM, Deswal A, Rouleau JL, LeWinter MM, Ofili EO, Stevenson LW, Semigran MJ, Felker GM, Chen HH, Hernandez AF, Anstrom KJ, McNulty SE, Velazquez EJ, Ibarra JC, Mascette AM, Braunwald E: Ultrafiltration in decompensated heart failure with cardiorenal syndrome. N Engl J Med 2012;367:2296-2304.
16.
Uttenthal O: NGAL: a marker molecule for the distressed kidney? Clin Lab Int 2005;29:39-41.
17.
Aghel A, Shrestha K, Mullens W, Borowski A, Tang WH: Serum neutrophil gelatinase-associated lipocalin (NGAL) in predicting worsening renal function in acute decompensated heart failure. J Card Fail 2010;16:49-54.
18.
Alvelos M, Pimentel R, Pinho E, Gomes A, Lourenco P, Teles MJ, Almeida P, Guimaraes JT, Bettencourt P: Neutrophil gelatinase-associated lipocalin in the diagnosis of type 1 cardio-renal syndrome in the general ward. Clin J Am Soc Nephrol 2011;6:476-481.
19.
Macdonald S, Arendts G, Nagree Y, Xu XF: Neutrophil gelatinase-associated lipocalin (NGAL) predicts renal injury in acute decompensated cardiac failure: a prospective observational study. BMC Cardiovasc Disord 2012;12:8.
20.
Yang X, Chen C, Tian J, Zha Y, Xiong Y, Sun Z, Chen P, Li J, Yang T, Ma C, Liu H, Wang X, Hou FF: Urinary angiotensinogen level predicts AKI in acute decompensated heart failure: a prospective, two-stage study. J Am Soc Nephrol 2015;26:2032-2041.
21.
Mortara A, Bonadies M, Mazzetti S, Fracchioni I, Delfino P, Chioffi M, Bersano C, Specchia G: Neutrophil gelatinase-associated lipocalin predicts worsening of renal function in acute heart failure: methodological and clinical issues. J Cardiovasc Med (Hagerstown) 2013;14:629-634.
22.
Breidthardt T, Socrates T, Drexler B, Noveanu M, Heinisch C, Arenja N, Klima T, Zusli C, Reichlin T, Potocki M, Twerenbold R, Steiger J, Mueller C: Plasma neutrophil gelatinase-associated lipocalin for the prediction of acute kidney injury in acute heart failure. Crit Care 2012;16:R2.
23.
Nymo SH, Ueland T, Askevold ET, Flo TH, Kjekshus J, Hulthe J, Wikstrand J, McMurray J, Van Veldhuisen DJ, Gullestad L, Aukrust P, Yndestad A: The association between neutrophil gelatinase-associated lipocalin and clinical outcome in chronic heart failure: results from CORONA. J Intern Med 2012;271:436-443.
24.
Saeed M, Lim V, Tappia P, Cordova F, Malik A, Rigatto C, Shafer L, Sood M, Zieroth S: Urinary NGAL is not associated with renal function changes or hospitalization in ambulatory heart failure patients. Can J Cardiol 2012;28:S280-S281.
25.
McIlroy DR, Wagener G, Lee HT: Neutrophil gelatinase-associated lipocalin and acute kidney injury after cardiac surgery: the effect of baseline renal function on diagnostic performance. Clin J Am Soc Nephrol 2010;5:211-219.
26.
Bolignano D, Donato V, Coppolino G, Campo S, Buemi A, Lacquaniti A, Buemi M: Neutrophil gelatinase-associated lipocalin (NGAL) as a marker of kidney damage. Am J Kidney Dis 2008;52:595-605.
27.
Bolignano D, Coppolino G, Donato V, Lacquaniti A, Bono C, Buemi M: Neutrophil gelatinase-associated lipocalin (NGAL): a new piece of the anemia puzzle? Med Sci Monit 2010;16:A131-A135.
28.
Velez JC: The importance of the intrarenal renin-angiotensin system. Nat Clin Pract Nephrol 2009;5:89-100.
29.
Kobori H, Harrison-Bernard LM, Navar LG: Urinary excretion of angiotensinogen reflects intrarenal angiotensinogen production. Kidney Int 2002;61:579-585.
30.
Liang KV, Williams AW, Greene EL, Redfield MM: Acute decompensated heart failure and the cardiorenal syndrome. Crit Care Med 2008;36:S75-S88.
31.
Waring WS, Moonie A: Earlier recognition of nephrotoxicity using novel biomarkers of acute kidney injury. Clin Toxicol (Phila) 2011;49:720-728.
32.
Damman K, Ng KCM, MacFadyen RJ, Lip GY, Gaze D, Collinson PO, Hillege HL, van Oeveren W, Voors AA, van Veldhuisen DJ: Volume status and diuretic therapy in systolic heart failure and the detection of early abnormalities in renal and tubular function. J Am Coll Cardiol 2011;57:2233-2241.
33.
Damman K, Masson S, Hillege HL, Voors AA, van Veldhuisen DJ, Rossignol P, Proietti G, Barbuzzi S, Nicolosi GL, Tavazzi L, Maggioni AP, Latini R: Tubular damage and worsening renal function in chronic heart failure. JACC Heart Fail 2013;1:417-424.
34.
Parikh CR, Mishra J, Thiessen-Philbrook H, Dursun B, Ma Q, Kelly C, Dent C, Devarajan P, Edelstein CL: Urinary IL-18 is an early predictive biomarker of acute kidney injury after cardiac surgery. Kidney Int 2006;70:199-203.
35.
Verbrugge FH, Dupont M, Shao Z, Shrestha K, Singh D, Finucan M, Mullens W, Tang WH: Novel urinary biomarkers in detecting acute kidney injury, persistent renal impairment, and all-cause mortality following decongestive therapy in acute decompensated heart failure. J Card Fail 2013;19:621-628.
36.
Jungbauer CG, Birner C, Jung B, Buchner S, Lubnow M, von Bary C, Endemann D, Banas B, Mack M, Boger CA, Riegger G, Luchner A: Kidney injury molecule-1 and N-acetyl-beta-D-glucosaminidase in chronic heart failure: possible biomarkers of cardiorenal syndrome. Eur J Heart Fail 2011;13:1104-1110.
37.
Hata N, Yokoyama S, Shinada T, Kobayashi N, Shirakabe A, Tomita K, Kitamura M, Kurihara O, Takahashi Y: Acute kidney injury and outcomes in acute decompensated heart failure: evaluation of the RIFLE criteria in an acutely ill heart failure population. Eur J Heart Fail 2010;12:32-37.
38.
Shirakabe A, Hata N, Kobayashi N, Shinada T, Tomita K, Tsurumi M, Matsushita M, Okazaki H, Yamamoto Y, Yokoyama S, Asai K, Mizuno K: Prognostic impact of acute kidney injury in patients with acute decompensated heart failure. Circ J 2013;77:687-696.
39.
Roy AK, Mc GC, Treacy C, Kavanaugh E, Brennan A, Mahon NG, Murray PT: A comparison of traditional and novel definitions (RIFLE, AKIN, and KDIGO) of acute kidney injury for the prediction of outcomes in acute decompensated heart failure. Cardiorenal Med 2013;3:26-37.
40.
Haase M, Muller C, Damman K, Murray PT, Kellum JA, Ronco C, McCullough PA: Pathogenesis of cardiorenal syndrome type 1 in acute decompensated heart failure: workgroup statements from the eleventh consensus conference of the Acute Dialysis Quality Initiative (ADQI). Contrib Nephrol 2013;182:99-116.
41.
Tang WH, Mullens W: Cardiorenal syndrome in decompensated heart failure. Heart 2010;96:255-260.
42.
Koyner JL, Vaidya VS, Bennett MR, Ma Q, Worcester E, Akhter SA, Raman J, Jeevanandam V, O'Connor MF, Devarajan P, Bonventre JV, Murray PT: Urinary biomarkers in the clinical prognosis and early detection of acute kidney injury. Clin J Am Soc Nephrol 2010;5:2154-2165.
43.
Steiner RW: Interpreting the fractional excretion of sodium. Am J Med 1984;77:699-702.
44.
Hilberman M, Myers BD, Carrie BJ, Derby G, Jamison RL, Stinson EB: Acute renal failure following cardiac surgery. J Thorac Cardiovasc Surg 1979;77:880-888.
45.
Yavuz I, Asgun FH, Bolcal C, Bingol H, Yokusoglu M, Baysan O, Ozgurtas T, Demirkilic U, Tatar H: Importance of urinary measurement of glutathione S-transferase in renal dysfunction patients after on- and off-pump coronary artery bypass surgery. Thorac Cardiovasc Surg 2009;57:125-129.
46.
Pepin MN, Bouchard J, Legault L, Ethier J: Diagnostic performance of fractional excretion of urea and fractional excretion of sodium in the evaluations of patients with acute kidney injury with or without diuretic treatment. Am J Kidney Dis 2007;50:566-573.
47.
Koyner JL, Garg AX, Coca SG, Sint K, Thiessen-Philbrook H, Patel UD, Shlipak MG, Parikh CR: Biomarkers predict progression of acute kidney injury after cardiac surgery. J Am Soc Nephrol 2012;23:905-914.
48.
Arthur JM, Hill EG, Alge JL, Lewis EC, Neely BA, Janech MG, Tumlin JA, Chawla LS, Shaw AD: Evaluation of 32 urine biomarkers to predict the progression of acute kidney injury after cardiac surgery. Kidney Int 2014;85:431-438.
49.
Alge JL, Karakala N, Neely BA, Janech MG, Tumlin JA, Chawla LS, Shaw AD, Arthur JM: Urinary angiotensinogen and risk of severe AKI. Clin J Am Soc Nephrol 2013;8:184-193.
50.
Hall IE, Stern EP, Cantley LG, Elias JA, Parikh CR: Urine YKL-40 is associated with progressive acute kidney injury or death in hospitalized patients. BMC Nephrol 2014;15:133.
51.
Hall IE, Yarlagadda SG, Coca SG, Wang Z, Doshi M, Devarajan P, Han WK, Marcus RJ, Parikh CR: IL-18 and urinary NGAL predict dialysis and graft recovery after kidney transplantation. J Am Soc Nephrol 2010;21:189-197.
52.
Belcher JM, Garcia-Tsao G, Sanyal AJ, Thiessen-Philbrook H, Peixoto AJ, Perazella MA, Ansari N, Lim J, Coca SG, Parikh CR: Urinary biomarkers and progression of AKI in patients with cirrhosis. Clin J Am Soc Nephrol 2014;9:1857-1867.
53.
Alge JL, Karakala N, Neely BA, Janech MG, Velez JC, Arthur JM: Urinary angiotensinogen predicts adverse outcomes among acute kidney injury patients in the intensive care unit. Crit Care 2013;17:R69.
54.
Chen C, Yang X, Lei Y, Zha Y, Liu H, Ma C, Tian J, Chen P, Yang T, Hou F: Urinary biomarkers at the time of AKI diagnosis as predictors of progression of AKI among patients with acute cardiorenal syndrome. Clin J Am Soc Nephrol 2016, DOI: 10.2215/CJN. 00910116.
55.
Ishani A, Xue JL, Himmelfarb J, Eggers PW, Kimmel PL, Molitoris BA, Collins AJ: Acute kidney injury increases risk of ESRD among elderly. J Am Soc Nephrol 2009;20:223-228.
56.
Venkatachalam MA, Griffin KA, Lan R, Geng H, Saikumar P, Bidani AK: Acute kidney injury: a springboard for progression in chronic kidney disease. Am J Physiol Renal Physiol 2010;298:F1078-F1094.
57.
Maisel AS, Mueller C, Fitzgerald R, Brikhan R, Hiestand BC, Iqbal N, Clopton P, van Veldhuisen DJ: Prognostic utility of plasma neutrophil gelatinase-associated lipocalin in patients with acute heart failure: the NGAL EvaLuation Along with B-type NaTriuretic Peptide in acutely decompensated heart failure (GALLANT) trial. Eur J Heart Fail 2011;13:846-851.
58.
Palazzuoli A, Ruocco G, Pellegrini M, De Gori C, Del CG, Franci B, Nuti R, Ronco C: Comparison of neutrophil gelatinase-associated lipocalin versus B-type natriuretic peptide and cystatin C to predict early acute kidney injury and outcome in patients with acute heart failure. Am J Cardiol 2015;116:104-111.
59.
Grodin JL, Perez AL, Wu Y, Hernandez AF, Butler J, Metra M, Felker GM, Voors AA, McMurray JJ, Armstrong PW, Califf RM, Starling RC, O'Connor CM, Tang WH: Circulating kidney injury molecule-1 levels in acute heart failure: insights from the ASCEND-HF trial (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure). JACC Heart Fail 2015;3:777-785.
60.
Taub PR, Gabbai-Saldate P, Maisel A: Biomarkers of heart failure. Congest Heart Fail 2010;16(suppl 1):S19-S24.
© 2016 S. Karger AG, Basel
2016
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.