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Urine, Blood Biomarkers to Predict CKD Progression

Researchers identify biomarkers to predict chronic kidney disease risk in hospitalized patients with acute kidney injury

Johns Hopkins Medicine
Published:Apr 03, 2023
|2 min read
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In a new study looking at the long-term effects of hospitalized patients who have acute kidney injury (AKI), a sudden but temporary loss of kidney function, Johns Hopkins Medicine researchers found that higher levels of certain biomarkers in urine and blood can predict a patient’s risk of developing chronic kidney disease (CKD).

The findings, published recently, in the Journal of Clinical Investigation, could help doctors better understand whether or not the body is healing properly, after someone sustains kidney damage, and potentially prevent the progression of acute kidney injury (AKI) to CKD.

AKI occurs when your kidneys stop working properly, which can cause waste to build up in your blood, making it hard for the body to balance fluids. Although treatable, AKI could lead to CKD—a much more severe and potentially fatal condition—and other heart problems. AKI is most commonly seen in hospitalized patients whose kidneys are affected by medical and surgical stress and complications, potentially resulting in a longer recovery process and prolonged harm to the kidneys.

“About 20 percent of hospitalized patients develop AKI and have a three- to eight-fold increased risk of developing chronic kidney disease later on in life,” says Chirag Parikh, MD, PhD, director of the Division of Nephrology at the Johns Hopkins University School of Medicine and the study’s corresponding author. “AKI incidence in the hospital continues to rise, so we set out to understand how and why AKI progresses to CKD, and if monitoring these patients over time can give us clues to kidney disease progression.”

According to the CDC, an estimated 37 million people are living with CKD in the US, making it the eighth leading cause of death in the country.

How biomarkers reflect kidney health in AKI patients

In a cohort of 656 hospitalized patients with AKI, researchers measured seven urine and two plasma biomarkers of kidney injury, inflammation, and tubular health at multiple time points over the course of a year after diagnosis. The goal was to determine the associations of longitudinal changes in these biomarkers with the progression of kidney disease after AKI. 

The researchers found that for each deviation increase in change of the biomarkers KIM-1, MCP-1 in urine and TNFRI in plasma was associated with a two- to three-fold increased risk for CKD.

Parikh says these findings suggest that sustained tissue injury and inflammation, as well as slower restoration of tubular health, are associated with a higher risk of kidney disease progression. However, they also observed that the increase in the urine biomarker UMOD was associated with a 40 percent reduced risk for CKD.

“Longitudinal measurement of some of these proteins have the potential to guide management of patients with AKI after discharge, which includes follow-up with a nephrologist; optimizing diabetes and cardiac medications; and accurate dosing of all medications with reduced kidney function,” says Parikh. 

He underscores the need for more research into these ongoing biological processes to help better understand the transition from AKI to CKD. 

- This press release was originally published on the John Hopkins Medicine website