Key result
A single NephroCheck test performed 4 hours after off-pump coronary artery bypass grafting did not significantly predict acute kidney injury (AUC 0.60, p=0.24).
Why the study?
NephroCheck was promising for detecting AKI after cardiac surgery with CPB, but its ability to predict AKI after off-pump CABG remained untested.
Does a single value of the NephroCheck test performed at 4 hours after surgery predict acute kidney injury in adult patients undergoing elective off-pump coronary artery bypass grafting?
Observational (n=90)
No
Does a single value of the NephroCheck test performed at 4 hours after surgery predict acute kidney injury in adult patients undergoing elective off-pump coronary artery bypass grafting?
A single NephroCheck test performed 4 hours after off-pump coronary artery bypass grafting does not reliably predict the development of acute kidney injury.
4-hour NephroCheck does not predict post-OPCABG AKI; leaves open its utility in off-pump settings pending further validation.
Background: Quantification of urinary tissue inhibitor of metalloproteinase-2 (TIMP-2) and insulin-like growth factor binding protein (IFGBP-7), which is commercially known as NephroCheck™(NC) test have been suggested as promising tools for the early detection of acute kidney injury (AKI) after cardiac surgery involving cardio-pulmonary bypass (CPB). Objectives: The aim of the present study was to test the hypothesis that single value of postoperative NC test performed at 4 hours after surgery can predict AKI in off-pump coronary artery bypass grafting (OPCABG) surgery. Setting and Design: This prospective single-center study was conducted at the tertiary cardiac center in India from December 2017 to November 2018. Methods: Ninety adult patients of both sex undergoing elective OPCABG were included. Anesthesia was standardized to all patients. Urine samples were collected preoperatively and at 4 hours after surgery for NC test. Urine output, serum creatinine, estimated glomerular filtration rate (eGFR) were also measured. AKI staging was based on kidney disease improving global outcomes (KDIGO) guidelines. Statistical Analysis: To assess the predictability of NC test for the primary endpoint, area under the receiver operating characteristic curve (ROC), was calculated. Results: Thirteen patients developed AKI in the study cohort (14.4%) out of which 7 patients (7.8%) developed stage 2/3 AKI and the remaining stage 1 AKI. Baseline renal parameters were similar between AKI and non-AKI group. The area under curve (AUC) of NC test at 4 hours after surgery was 0.60 [95% confidence interval (CI): 0.42-0.77]. Postoperative NC test performed at 4 hours after surgery did not predict AKI in this study population (P = 0.24). There were no significant differences in duration of mechanical ventilation, length of intensive care stay and hospital stay between the two groups (P > 0.05). Conclusion: test performed at 4 hours after surgery did not identify patients at risk for developing AKI following OPCABG surgery.
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Kanchi et al. (2023) conducted an observational in Acute Kidney Injury following Off-Pump Coronary Artery Bypass Grafting (n=90). NephroCheck test at 4 hours post-surgery was evaluated on Prediction of Acute Kidney Injury (AKI) (AUC 0.60, 95% CI 0.42-0.77, p=0.24). A single NephroCheck test performed 4 hours after off-pump coronary artery bypass grafting did not significantly predict acute kidney injury (AUC 0.60, p=0.24).
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