Long-Term Consequences of Increased Activity of Urine Enzymes After Cardiac Surgery - A Prospective Observational Study

Jowita Biernawska; Katarzyna Kotfis; Jolanta Szymańska-Pasternak; Anna Bogacka; Joanna Bober

doi:10.2147/TCRM.S371288

Long-Term Consequences of Increased Activity of Urine Enzymes After Cardiac Surgery - A Prospective Observational Study

Ther Clin Risk Manag. 2022 Aug 26:18:867-877. doi: 10.2147/TCRM.S371288. eCollection 2022.

Authors

Jowita Biernawska¹, Katarzyna Kotfis², Jolanta Szymańska-Pasternak³, Anna Bogacka⁴, Joanna Bober³

Affiliations

¹ Department of Anesthesiology and Intensive Therapy, Pomeranian Medical University, Szczecin, Poland.
² Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, Szczecin, Poland.
³ Department of Medical Chemistry, Pomeranian Medical University, Szczecin, Poland.
⁴ Department of Commodity Science, Quality Assessment, Process Engineering and Human Nutrition, West Pomeranian University of Technology, Szczecin, Poland.

Abstract

Introduction: Cardiac surgery associated AKI (CSA-AKI) complicates recovery and may be associated with a greater risk of developing chronic kidney disease and mortality. The aim of this study was to assess long-term clinical consequences of transient increased activity of urinary enzymes after cardiac surgery (CS).

Methods: An observational study was conducted in a group of 88 adult patients undergoing planned coronary artery bypass grafting (CABG), but all samples were obtained from 79 patients. The activity of urinary enzymes: N-acetyl-beta-glucosaminidase (NAG), arylsulfatase A (ASA) and beta-glucuronidase was evaluated in sequential urine samples. A comparative analysis of biochemical parameters was performed regarding the occurrence of acute kidney injury (AKI) defined by KIDGO at 24 hours, at day 30 and 5-years after the operation.

Results: During the first 24 hours after CS AKI was diagnosed in 13 patients. A comparison of the activity of urinary enzymes in pre-defined time-points showed significant differences for ASA and NAG (post OP-sample p < 0.028 and p < 0.022; POD 1 sample p < 0.004 and p < 0.001 respectively). No patient had any biochemical or clinical features of kidney failure at day 30. In the AKI group kidney failure was diagnosed in 36% of patients within 5 years of follow-up as opposed to 5% in the no AKI group. The activities of tubular enzymes in urine reflect a general injury of kidney tubules during and after the operation. However, they are not ideal biomarkers for prediction of the degree of kidney injury and further poor prognosis of CS-AKI.

Keywords: AKI; ASA; B-GR; N-acetyl-beta-glucosaminidase; NAG; acute kidney injury; arylsulfatase A; beta-glucuronidase; cardiac surgery.