TY - JOUR
T1 - Elevated suPAR Is an Independent Risk Marker for Incident Kidney Disease in Acute Medical Patients
AU - Iversen, Esben
AU - Houlind, Morten Baltzer
AU - Kallemose, Thomas
AU - Rasmussen, Line Jee Hartmann
AU - Hornum, Mads
AU - Feldt-Rasmussen, Bo
AU - Hayek, Salim S.
AU - Andersen, Ove
AU - Eugen-Olsen, Jesper
PY - 2020
Y1 - 2020
N2 - Introduction Identifying patients at high risk of developing kidney disease could lead to early clinical interventions that prevent or slow disease progression. Soluble urokinase plasminogen activator receptor (suPAR) is an inflammatory biomarker thought to be involved in the pathogenesis and development of kidney disease. We aimed to determine whether elevated plasma suPAR measured at hospital admission is associated with incident kidney disease in patients presenting to the emergency department. Materials and Methods This was a retrospective registry-based cohort study performed at the Emergency Department of Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark. Patients were included in the study from November 2013 to March 2017 and followed until June 2017. Patients were excluded if they were diagnosed with kidney disease or died prior to index discharge. Plasma suPAR was measured at hospital admission, and the main outcome was time to incident kidney disease, defined by ICD-10 diagnosis codes for both chronic and acute kidney conditions. Association between suPAR and time to incident kidney disease was assessed by Cox proportional hazard regression analysis. Results In total, 25,497 patients (median age 58.1 years; 52.5% female) were admitted to the emergency department and followed for development of kidney disease. In multivariable Cox regression analysis adjusting for age, sex, eGFR, CRP, cardiovascular disease, hypertension, and diabetes, each doubling in suPAR at hospital admission was associated with a hazard ratio of 1.57 (95% CI: 1.38-1.78,P<0.001) for developing a chronic kidney condition and 2.51 (95% CI: 2.09-3.01,P<0.001) for developing an acute kidney condition. Discussion In a large cohort of acutely hospitalized medical patients, elevated suPAR was independently associated with incident chronic and acute kidney conditions. This highlights the potential for using suPAR in risk classification models to identify high-risk patients who could benefit from early clinical interventions. The main limitation of this study is its reliance on accurate reporting of ICD-10 codes for kidney disease.
AB - Introduction Identifying patients at high risk of developing kidney disease could lead to early clinical interventions that prevent or slow disease progression. Soluble urokinase plasminogen activator receptor (suPAR) is an inflammatory biomarker thought to be involved in the pathogenesis and development of kidney disease. We aimed to determine whether elevated plasma suPAR measured at hospital admission is associated with incident kidney disease in patients presenting to the emergency department. Materials and Methods This was a retrospective registry-based cohort study performed at the Emergency Department of Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark. Patients were included in the study from November 2013 to March 2017 and followed until June 2017. Patients were excluded if they were diagnosed with kidney disease or died prior to index discharge. Plasma suPAR was measured at hospital admission, and the main outcome was time to incident kidney disease, defined by ICD-10 diagnosis codes for both chronic and acute kidney conditions. Association between suPAR and time to incident kidney disease was assessed by Cox proportional hazard regression analysis. Results In total, 25,497 patients (median age 58.1 years; 52.5% female) were admitted to the emergency department and followed for development of kidney disease. In multivariable Cox regression analysis adjusting for age, sex, eGFR, CRP, cardiovascular disease, hypertension, and diabetes, each doubling in suPAR at hospital admission was associated with a hazard ratio of 1.57 (95% CI: 1.38-1.78,P<0.001) for developing a chronic kidney condition and 2.51 (95% CI: 2.09-3.01,P<0.001) for developing an acute kidney condition. Discussion In a large cohort of acutely hospitalized medical patients, elevated suPAR was independently associated with incident chronic and acute kidney conditions. This highlights the potential for using suPAR in risk classification models to identify high-risk patients who could benefit from early clinical interventions. The main limitation of this study is its reliance on accurate reporting of ICD-10 codes for kidney disease.
KW - chronic kidney disease
KW - acute kidney injury
KW - dialysis
KW - soluble urokinase plasminogen activator receptor
KW - glomerular filtration rate
KW - emergency department
KW - PLASMINOGEN-ACTIVATOR RECEPTOR
KW - GLOMERULAR-FILTRATION-RATE
KW - SOLUBLE UROKINASE RECEPTOR
KW - CARDIOVASCULAR-DISEASE
KW - EMERGENCY-DEPARTMENT
KW - RENAL-FUNCTION
KW - ALBUMINURIA
KW - GUIDELINE
KW - MORTALITY
KW - GUIDANCE
U2 - 10.3389/fcell.2020.00339
DO - 10.3389/fcell.2020.00339
M3 - Journal article
C2 - 32596235
VL - 8
JO - Frontiers in Cell and Developmental Biology
JF - Frontiers in Cell and Developmental Biology
SN - 2296-634X
M1 - 339
ER -