Cystatin C and Kidney Function Recovery in Patients Requiring Continuous Kidney Replacement Therapy for Acute Kidney Injury.

Haeger SM, Okamura K, Li AS, He Z, Park BD, Budnick IM, Foulon N, Kennis M, Blaine R, Miyazaki M, Campbell R, Jalal DI, Colbert JF, Brinton JT, Griffin BR, Faubel S. Cystatin C and Kidney Function Recovery in Patients Requiring Continuous Kidney Replacement Therapy for Acute Kidney Injury. Clinical journal of the American Society of Nephrology : CJASN. 2024 Aug 21.

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Abstract:

BACKGROUND: Plasma cystatin C is a reliable marker to estimate kidney function; however, it is unknown whether this remains true in patients receiving continuous kidney replacement therapy (CKRT). Herein, we tested the hypothesis that lower concentrations of plasma cystatin C during the first three days of CKRT would predict kidney function recovery. METHODS: We performed a retrospective observational study of 72 patients from a 126-patient, single-center CKRT study. We studied two a priori defined cohorts of patients without advanced CKD who had acute kidney injury requiring CKRT (AKI-CKRT): 1) with early kidney function recovery defined as liberation from KRT within seven days of CKRT initiation versus 2) with delayed kidney function recovery defined as receipt of KRT for > 21 days or death while on KRT. Subsequent analysis included patients with advanced CKD and intermediate kidney function recovery (liberation between 8 and 21 days). Cystatin C was then measured on stored plasma, urine, and dialysis effluent collected prior to CKRT initiation and on days 1, 2, and 3 of CKRT. RESULTS: Plasma cystatin C was significantly lower in patients with early kidney function recovery in comparison to patients with delayed kidney function recovery on days 1 (1.79 vs. 2.39mg/L), 2 (1.91 vs. 2.38mg/L) and 3 (2.04 vs. 2.67mg/L) of CKRT. Sieving coefficient and CKRT clearance of cystatin C were similar for patients with early and delayed kidney function recovery. The lowest plasma cystatin C concentration on days 1-3 of CKRT predicted early kidney function recovery with an area under the receiver operating curve of 0.77 (P = 0.002), positive likelihood ratio of 5.60 for plasma cystatin C < 1.30mg/L, and negative likelihood ratio of 0.17 for plasma cystatin C 1.88mg/L. CONCLUSION: Lower plasma cystatin C concentrations during the first three days of CKRT are associated with early kidney function recovery.