Evidence map›Paper›PMID 34515046›Full record

ArticleAmerican journal of nephrology2021

Urine Alpha-1-Microglobulin Levels and Acute Kidney Injury, Mortality, and Cardiovascular Events following Cardiac Surgery.

Jonathan G Amatruda, Michelle M Estrella, Amit X Garg, Heather Thiessen-Philbrook, Eric McArthur, Steven G Coca, Chirag R Parikh, Michael G Shlipak, TRIBE-AKI Consortium

Open access · hybridAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in American journal of nephrology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers.

0numbers the graph read from it
0cells of the map it votes in
20citing papers in PubMed
2.0field-weighted citation impact, top 13% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

20 citing papers in PubMed, 22 citations in OpenAlex.

  1. Article
  2. Article
  3. Article
  4. Article
  5. Review
  6. Article
  7. Review
  8. Article
  9. Review
  10. Article
  11. Article
  12. Article
  13. Article
  14. Article
  15. Article
  16. Review
  17. Article
  18. Review
  19. Review
  20. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

9 authors at 5 institutions in 2 countries.

Jonathan G AmatrudaDivision of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA, jonathan.amatruda@ucsf.edu.
Michelle M EstrellaDivision of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA.
Amit X GargSchulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Heather Thiessen-PhilbrookJohns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Eric McArthurICES, Toronto, Ontario, Canada.
Steven G CocaIcahn School of Medicine at Mount Sinai, New York, New York, USA.
Chirag R ParikhJohns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Michael G ShlipakKidney Health Research Collaborative, San Francisco VA Health Care System & University of California, San Francisco, San Francisco, California, USA.
TRIBE-AKI Consortium
University of California, San Francisco · USJohns Hopkins University · USIcahn School of Medicine at Mount Sinai · USInstitute for Clinical Evaluative Sciences · CAWestern University · CA

Funding

Renal Physiology and Phenotyping CoreP30DK079310 · NIDDK · YALE UNIVERSITY · PI ARONSON, PETER S. · 2008 to 2022
$16.8M
Novel Biomarkers in Cardiac Surgery to Detect Acute Kidney InjuryR01HL085757 · NHLBI · YALE UNIVERSITY · PI PARIKH, CHIRAG R · 2007 to 2019
$10.3M
Academic Training Program in NephrologyT32DK007219 · NIDDK · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI HSU, CHI-YUAN · 1986 to 2022
$7.3M
Progression of Acute Kidney Injury to Chronic Kidney DiseaseU01DK082185 · NIDDK · YALE UNIVERSITY · PI PARIKH, CHIRAG R · 2008 to 2017
$5.1M
NSAID Use and Multidimensional Assessment of Kidney HealthF32DK126381 · NIDDK · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI AMATRUDA, JONATHAN · 2020 to 2021
$153k
NHLBI NIH HHS R01 HL085757NIDDK NIH HHS F32 DK126381NIDDK NIH HHS P30 DK079310NIDDK NIH HHS T32 DK007219NIDDK NIH HHS U01 DK082185
6 · The paper itself

Abstract

introductionUrine alpha-1-microglobulin (Uα1m) elevations signal proximal tubule dysfunction. In ambulatory settings, higher Uα1m is associated with acute kidney injury (AKI), progressive chronic kidney disease (CKD), cardiovascular (CV) events, and mortality. We investigated the associations of pre- and postoperative Uα1m concentrations with adverse outcomes after cardiac surgery.

methodsIn 1,464 adults undergoing cardiac surgery in the prospective multicenter Translational Research Investigating Biomarker Endpoints for Acute Kidney Injury (TRIBE-AKI) cohort, we measured the pre-and postoperative Uα1m concentrations and calculated the changes from pre- to postoperative concentrations. Outcomes were postoperative AKI during index hospitalization and longitudinal risks for CKD incidence and progression, CV events, and all-cause mortality after discharge. We analyzed Uα1m continuously and categorically by tertiles using multivariable logistic regression and Cox proportional hazards regression adjusted for demographics, surgery characteristics, comorbidities, baseline estimated glomerular filtration rate, urine albumin, and urine creatinine.

resultsThere were 230 AKI events during cardiac surgery hospitalization; during median 6.7 years of follow-up, there were 212 cases of incident CKD, 54 cases of CKD progression, 269 CV events, and 459 deaths. Each 2-fold higher concentration of preoperative Uα1m was independently associated with AKI (adjusted odds ratio [aOR] = 1.36, 95% confidence interval 1.14-1.62), CKD progression (adjusted hazard ratio [aHR] = 1.46, 1.04-2.05), and all-cause mortality (aHR = 1.19, 1.06-1.33) but not with incident CKD (aHR = 1.21, 0.96-1.51) or CV events (aHR = 1.01, 0.86-1.19). Postoperative Uα1m was not associated with AKI (aOR per 2-fold higher = 1.07, 0.93-1.22), CKD incidence (aHR = 0.90, 0.79-1.03) or progression (aHR = 0.79, 0.56-1.11), CV events (aHR = 1.06, 0.94-1.19), and mortality (aHR = 1.01, 0.92-1.11).

conclusionPreoperative Uα1m concentrations may identify patients at high risk of AKI and other adverse events after cardiac surgery, but postoperative Uα1m concentrations do not appear to be informative.

Indexed as

Cardiac Surgical ProceduresAcute Kidney InjuryAgedAged, 80 and overAlpha-GlobulinsCardiovascular DiseasesFemaleHumansMaleMiddle AgedPostoperative ComplicationsProspective Studiesalpha-1-microglobulinAlpha-GlobulinsAcute kidney injuryAlpha-1-microglobulinBiomarkerCardiac surgeryChronic kidney diseaseMortality

Identifiers

PMID34515046
PMCPMC8619798
OpenAlexW3197831788

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.