The following is a summary of “Evaluation of Proenkephalin A 119–159 for liberation from renal replacement therapy: an external, multicenter pilot study in critically ill patients with acute kidney injury,” published in the July 2023 issue of Critical Care by Groote et al.
For a study, researchers conducted a multicenter pilot study and observed the successful application of plasma Proenkephalin A 119–159 (penKid) in initiating early renal replacement therapy for critically ill patients diagnosed with acute kidney injury (AKI).
Researchers performed a retrospective study to validate the association of plasma Proenkephalin A 119–159 (penKid) with early and successful liberation from continuous renal replacement therapy (CRRT) in critically ill patients with AKI.
Data and plasma samples from the Randomized Clinical Trial (RICH) were utilized. PenKid levels were measured in all plasma samples at the beginning and on day 3 of CRRT. Patients were divided into low and high penKid groups using a cutoff at 100 pmol/l. Competing-risk time-to-event analyses were conducted, with competing risk endpoints being successful and unsuccessful liberation from CRRT. Unsuccessful liberation included death or needing a new renal replacement therapy (RRT) within one week after discontinuing primary CRRT. The study then compared penKid levels with urinary output.
Results showed the link between pre-CRRT penKid levels and early and successful release from CRRT was not crucial (subdistribution hazard ratio [sHR] 1.01, 95% CI 0.73–1.40, P= 0.945). However, in the landmark analysis on day 3 of ongoing CRRT, low penKid levels were associated with successful release (sHR 2.35, 95% CI 1.45–3.81, P< 0.001), while high penKid levels were associated with unsuccessful release (sHR 0.46, 95% CI 0.26–0.80, P=0.007). Notably, high daily urinary output (>436 ml/d) showed a stronger connection with conquering deliverance (sHR 2.91, 95% CI 1.80–4.73, P< 0.001) compared to penKid.
They concluded penKid as a biomarker for monitoring kidney function recovery in CRRT. Low penKid predicts early liberation, outperforming high urinary output.
Source: ccforum.biomedcentral.com/articles/10.1186/s13054-023-04556-w