Key result
Delta PENK levels improve early detection of contrast-induced AKI over creatinine with a 0.92 AUC.
Why the study?
Does Proenkephalin (PENK) measurement improve the early detection of contrast-induced acute kidney injury in hospitalized patients with chronic kidney disease compared to serum creatinine?
Observational (n=111)
Blinded
Does Proenkephalin (PENK) measurement improve the early detection of contrast-induced acute kidney injury in hospitalized patients with chronic kidney disease compared to serum creatinine?
Effect estimate: AUC 0.92 (95% CI 0.82-1.00)
Delta PENK levels improve the early detection of contrast-induced AKI in CKD patients over serial creatinine sampling, accelerating detection by 24 hours.
Delta PENK may enable earlier contrast-induced AKI detection in CKD; leaves open whether serial measurement improves outcomes over creatinine in prospective studies.
BACKGROUND: The early detection of acute kidney injury (AKI) in patients with chronic kidney disease (CKD) is an unmet clinical need. Proenkephalin (PENK) might improve the early detection of AKI. METHODS: One hundred and eleven hospitalized CKD patients undergoing radiographic contrast procedures were enrolled. PENK was measured in a blinded fashion at baseline (before contrast media administration) and on day 1 (after contrast media administration). The potential of PENK levels to predict contrast-induced AKI was the primary endpoint. RESULTS: Baseline creatinine and baseline PENK were similar in AKI and no-AKI patients. In AKI patients, day 1 PENK (198 pmol/L vs 121 pmol/L, P < 0.01) was significantly higher compared to no-AKI patients. The area under the curve (AUC) for the prediction of AKI by day 1 PENK was 0.79, 95% CI: 0.70-0.87, similar to serum creatinine: 0.78, 95% CI: 0.61-0.95. Delta PENK was significantly higher in AKI compared to no-AKI patients (53 pmol/L vs 1 pmol/L, P < 0.01). The AUC for the prediction of AKI by delta PENK was high (0.92, 95%CI 0.82-1.00) and remained high for creatinine-blind AKI (0.94, 95% CI: 0.87-0.97). CONCLUSION: Delta PENK levels improve the early detection of contrast-induced AKI in CKD patients over serial creatinine sampling. Delta PENK accelerates the detection of creatinine-blind AKI by 24 hours.
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Breidthardt et al. (2018) conducted an observational in Chronic kidney disease undergoing radiographic contrast procedures (n=111). Proenkephalin (PENK) levels vs. Serum creatinine was evaluated on Prediction of contrast-induced acute kidney injury (AUC 0.92, 95% CI 0.82-1.00). Delta proenkephalin (PENK) levels accurately predicted contrast-induced acute kidney injury (AUC 0.92; 95% CI 0.82-1.00), improving early detection over serial creatinine sampling.
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