To decipher the diagnostic value of serum cystatin C (CysC), β2-microglobulin (β2-MG) and α-Klotho in early acute kidney injury (AKI) caused by acute myocardial infarction (AMI).

Methods

This study screened 176 eligible patients and established two groups of AKI group (n = 51) and non-AKI group (n = 125). This study measured and compared the serum CysC, β2-MG, α-Klotho, serum creatinine (Scr), blood urea nitrogen (BUN), creatine kinase isoenzymes MB (CK-MB) and cardiac troponin T (cTnI) between the two groups. This study further analyzed correlations of CysC, β2-MG and α-Klotho with Scr and BUN, and the relationship of various indicators with AKI, with receiver operating characteristic (ROC) curves plotted.

Results

AKI group was detected with significant changes in baseline data compared with non-AKI group. Serum CysC, β2-MG and α-Klotho had significantly positive correlations with Scr and BUN. CK-MB, Scr, BUN, CysC, β2-MG, and α-Klotho were independent risk factors for AKI in AMI patients. The AUC, sensitivity, and specificity of CysC for predicting AKI were 0.840, 0.627, and 0.984; which were 0.835, 0.784, and 0.864 for β2-MG; 0.881, 0.824, and 0.832 for α-Klotho; as well as 0.913, 0.843, and 0.880 when using three indicators jointly. Joint detection had better predictive performance for AKI than any single indicator.

Conclusion

Serum CysC, β2-MG and α-Klotho are significantly positively correlated with reduced renal function and are independent risk factors for AKI, exhibiting high early diagnostic value for AKI in AMI patients.

Conflicts of Interest

The authors declare no conflicts of interest.

Open Research

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

References

1L. Buldak, “Cardiovascular Diseases-A Focus on Atherosclerosis, Its Prophylaxis, Complications and Recent Advancements in Therapies,” International Journal of Molecular Sciences 23, no. 9 (April 2022): 4695.
10.3390/ijms23094695
PubMed Web of Science® Google Scholar
2G. A. Roth, G. A. Mensah, C. O. Johnson, et al, “Global Burden of Cardiovascular Diseases and Risk Factors, 1990–2019,” Journal of the American College of Cardiology 76, no. 25 (December 2020): 2982–3021.
10.1016/j.jacc.2020.11.010
PubMed Web of Science® Google Scholar
3A. Khwaja, “Kdigo Clinical Practice Guidelines for Acute Kidney Injury,” Nephron Clinical Practice 120, no. 4 (2012): c179–c184.
10.1159/000339789
PubMed Web of Science® Google Scholar
4R. Chandiramani, D. Cao, J. Nicolas, and R. Mehran, “Contrast-Induced Acute Kidney Injury,” Cardiovascular Intervention and Therapeutics 35, no. 3 (July 2020): 209–217.
10.1007/s12928-020-00660-8
PubMed Web of Science® Google Scholar
5N. Moriyama, M. Ishihara, T. Noguchi, et al., “Early Development of Acute Kidney Injury is an Independent Predictor of in-Hospital Mortality in Patients With Acute Myocardial Infarction,” Journal of Cardiology 69, no. 1 (January 2017): 79–83.
10.1016/j.jjcc.2016.01.001
PubMed Web of Science® Google Scholar
6J. P. Vavalle, S. van Diepen, R. M. Clare, et al., “Renal Failure in Patients With ST-Segment Elevation Acute Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention: Predictors, Clinical and Angiographic Features, and Outcomes,” American Heart Journal 173 (March 2016): 57–66.
10.1016/j.ahj.2015.12.001
PubMed Web of Science® Google Scholar
7M. Heung, D. E. Steffick, K. Zivin, et al., “Acute Kidney Injury Recovery Pattern and Subsequent Risk of CKD: An Analysis of Veterans Health Administration Data,” American Journal of Kidney Diseases 67, no. 5 (May 2016): 742–752.
10.1053/j.ajkd.2015.10.019
PubMed Web of Science® Google Scholar
8X. Chen, W. Wei, Y. Li, J. Huang, and X. Ci, “Hesperetin Relieves Cisplatin-Induced Acute Kidney Injury by Mitigating Oxidative Stress, Inflammation and Apoptosis,” Chemico-Biological Interactions 308 (August 2019): 269–278.
10.1016/j.cbi.2019.05.040
CAS PubMed Web of Science® Google Scholar
9J. S. Stevens, K. Xu, A. Corker, et al., “Rule Out Acute Kidney Injury in the Emergency Department With a Urinary Dipstick,” Kidney International Reports 5, no. 11 (November 2020): 1982–1992.
10.1016/j.ekir.2020.09.006
PubMed Web of Science® Google Scholar
10A. Y. Leem, M. S. Park, B. H. Park, et al., “Value of Serum Cystatin C Measurement in the Diagnosis of Sepsis-Induced Kidney Injury and Prediction of Renal Function Recovery,” Yonsei Medical Journal 58, no. 3 (May 2017): 604–612.
10.3349/ymj.2017.58.3.604
CAS PubMed Web of Science® Google Scholar
11Z. Zhang, B. Lu, X. Sheng, and N. Jin, “Cystatin C in Prediction of Acute Kidney Injury: A Systemic Review and Meta-Analysis,” American Journal of Kidney Diseases 58, no. 3 (September 2011): 356–365.
10.1053/j.ajkd.2011.02.389
CAS PubMed Web of Science® Google Scholar
12W. Yuan, J. Y. Wu, Y. Z. Zhao, et al., “Effect of Mild Hypothermia on Renal Ischemia/Reperfusion Injury After Cardiopulmonary Resuscitation in a Swine Model,” Acta Cirurgica Brasileira 32, no. 7 (July 2017): 523–532.
10.1590/s0102-865020170070000003
PubMed Web of Science® Google Scholar
13R. Wald, O. Liangos, M. C. Perianayagam, et al., “Plasma Cystatin C and Acute Kidney Injury After Cardiopulmonary Bypass,” Clinical Journal of the American Society of Nephrology 5, no. 8 (August 2010): 1373–1379.
10.2215/CJN.06350909
CAS PubMed Web of Science® Google Scholar
14D. Steubl and L. A. Inker, “How Best to Estimate Glomerular Filtration Rate? Novel Filtration Markers and Their Application,” Current Opinion in Nephrology and Hypertension 27, no. 6 (November 2018): 398–405.
10.1097/MNH.0000000000000444
PubMed Google Scholar
15G. H. C. Schardijn and L. W. S. van Eps, “β2-microglobulin: Its Significance in the Evaluation of Renal Function,” Kidney International 32, no. 5 (November 1987): 635–641.
10.1038/ki.1987.255
CAS PubMed Web of Science® Google Scholar
16M. Sakurai, Y. Suwazono, M. Nishijo, et al., “The Relationship between the Urinary Cadmium Concentration and Cause-Specific Mortality in Subjects Without Severe Renal Damage: A 35-Year Follow-Up Study in a Cadmium-Polluted Area of Japan,” International Journal of Environmental Research and Public Health 18, no. 15 (July 2021): 7747.
10.3390/ijerph18157747
CAS PubMed Web of Science® Google Scholar
17R. Wang, H. Hu, S. Hu, H. He, and H. Shui, “β2-microglobulin is an Independent Indicator of Acute Kidney Injury and Outcomes in Patients With Intracerebral Hemorrhage,” Medicine 99, no. 8 (February 2020): e19212.
10.1097/MD.0000000000019212
CAS PubMed Google Scholar
18W. H. Moos, D. V. Faller, I. P. Glavas, et al., “Klotho Pathways, Myelination Disorders, Neurodegenerative Diseases, and Epigenetic Drugs,” BioResearch Open Access 9, no. 1 (2020): 94–105.
10.1089/biores.2020.0004
CAS PubMed Web of Science® Google Scholar
19Q. Cai, S. Hu, C. Qi, et al., “Serum Anti-Aging Protein α-Klotho Mediates the Association Between Diet Quality and Kidney Function,” Nutrients 15, no. 12 (June 2023): 2744.
10.3390/nu15122744
CAS PubMed Google Scholar
20M. C. Hu, M. Shi, J. Zhang, et al., “Renal Production, Uptake, and Handling of Circulating αKlotho,” Journal of the American Society of Nephrology 27, no. 1 (January 2016): 79–90.
10.1681/ASN.2014101030
CAS PubMed Web of Science® Google Scholar
21Y. Pei, M. Miu, X. Mao, et al, “Alpha-Klotho: An Early Risk-Predictive Biomarker for Acute Kidney Injury in Patients With Acute Myocardial Infarction,” International Journal of Clinical Practice 2023 (2023): 8244545.
10.1155/2023/8244545
PubMed Web of Science® Google Scholar
22J. S. Alpert, K. Thygesen, A. Jaffe, and H. D. White, “The Universal Definition of Myocardial Infarction: A Consensus Document: Ischaemic,” Heart (British Cardiac Society) 94, no. 10 (October 2008): 1335–1341.
10.1136/hrt.2008.151233
PubMed Web of Science® Google Scholar
23J. Matuszkiewicz-Rowinska and J. Malyszko, “Acute Kidney Injury, Its Definition, and Treatment in Adults: Guidelines and Reality,” Polish Archives of Internal Medicine 130, no. 12 (December 2020): 1074–1080.
PubMed Web of Science® Google Scholar
24X. Wang and X. Fu, “Predicting AKI In Patients With AMI: Development and Assessment of a New Predictive Nomogram,” Medicine 102, no. 24 (June 2023): e33991.
10.1097/MD.0000000000033991
PubMed Web of Science® Google Scholar
25Y. Pei, W. Chen, X. Mao, and J. Zhu, “Serum Cystatin C, Klotho, and Neutrophil Gelatinase-Associated Lipocalin in the Risk Prediction of Acute Kidney Injury After Acute Myocardial Infarction,” Cardiorenal Medicine 10, no. 6 (2020): 374–381.
10.1159/000507387
CAS PubMed Web of Science® Google Scholar
26Z. Chen, J. Zhang, J. Feng, G. Zhou, X. Jin, and J. Pan, “Higher Serum Level of Cystatin C: An Additional Risk Factor of CAD,” Medicine 100, no. 2 (January 2021): e24269.
10.1097/MD.0000000000024269
CAS PubMed Web of Science® Google Scholar
27C. M. Oberg, M. Lindstrom, A. Grubb, et al, “Potential Relationship Between eGFR(Cystatin C)/eGFR(Creatinine)-Ratio and Glomerular Basement Membrane Thickness in Diabetic Kidney Disease,” Physiological Reports 9, no. 13 (July 2021): e14939.
10.14814/phy2.14939
CAS PubMed Web of Science® Google Scholar
28A. Barbati, B. Cappuccini, M. C. Aisa, et al., “Increased Urinary Cystatin-C Levels Correlate With Reduced Renal Volumes in Neonates With Intrauterine Growth Restriction,” Neonatology 109, no. 2 (2016): 154–160.
10.1159/000441273
CAS PubMed Web of Science® Google Scholar
29D. C. Chen, O. A. Potok, D. Rifkin, and M. M. Estrella, “Advantages, Limitations, and Clinical Considerations in Using Cystatin C to Estimate GFR,” Kidney360 3, no. 10 (October 2022): 1807–1814.
10.34067/KID.0003202022
PubMed Web of Science® Google Scholar
30S. W. Benoit, E. A. Ciccia, and P. Devarajan, “Cystatin C as a Biomarker of Chronic Kidney Disease: Latest Developments,” Expert Review of Molecular Diagnostics 20, no. 10 (October 2020): 1019–1026.
10.1080/14737159.2020.1768849
CAS PubMed Web of Science® Google Scholar
31J. R. Shin, S. M. Kim, J. S. Yoo, et al., “Urinary Excretion of β2-microglobulin as a Prognostic Marker in Immunoglobulin A Nephropathy,” Korean Journal of Internal Medicine 29, no. 3 (May 2014): 334–340.
10.3904/kjim.2014.29.3.334
CAS Google Scholar
32F. Liu, W. Ni, J. Zhang, G. Wang, F. Li, and W. Ren, “Administration of Curcumin Protects Kidney Tubules Against Renal Ischemia-Reperfusion Injury (RIRI) by Modulating Nitric Oxide (NO) Signaling Pathway,” Cellular Physiology and Biochemistry 44, no. 1 (2017): 401–411.
10.1159/000484920
CAS PubMed Web of Science® Google Scholar
33M. Zuo, C. Meng, Q. Song, et al., “Beta-Hydroxybutyric Acid Inhibits Renal Tubular Reabsorption via the AKT/DAB2/Megalin Signalling Pathway,” Journal of Diabetes Research 2022 (2022): 3411123.
10.1155/2022/3411123
PubMed Web of Science® Google Scholar
34Y. Murano, H. Shoji, T. Hara, et al., “Long-Term Renal Tubular Damage in Intrauterine Growth-Restricted Rats,” Pediatrics International 60, no. 6 (June 2018): 565–568.
10.1111/ped.13570
CAS PubMed Web of Science® Google Scholar
35J. Yan, C. Jingbo, D. Wang, et al., “A Correlation Between Decreased Parathyroid α-Klotho and Fibroblast Growth Factor Receptor 1 Expression With Pathological Category and Parathyroid Gland Volume in Dialysis Patients,” International Urology and Nephrology 47, no. 4 (April 2015): 701–706.
10.1007/s11255-015-0917-0
CAS PubMed Google Scholar
36G. J. Prud'homme, M. Kurt, and Q. Wang, “Pathobiology of the Klotho Antiaging Protein and Therapeutic Considerations,” Frontiers in Aging 3 (2022): 931331.
10.3389/fragi.2022.931331
PubMed Web of Science® Google Scholar
37S. S. Kim, S. H. Song, I. J. Kim, et al., “Decreased Plasma α-Klotho Predict Progression of Nephropathy With Type 2 Diabetic Patients,” Journal of Diabetes and Its Complications 30, no. 5 (July 2016): 887–892.
10.1016/j.jdiacomp.2016.03.006
PubMed Web of Science® Google Scholar
38S. Pajenda, A. Ilhan-Mutlu, M. Preusser, S. Roka, W. Druml, and L. Wagner, “Nephrocheck Data Compared to Serum Creatinine in Various Clinical Settings,” BMC Nephrology 16 (December 2015): 206.
10.1186/s12882-015-0203-5
PubMed Web of Science® Google Scholar
39J. D. Brunker, N. M. Ponzio, and M. E. Payton, “Indices of Urine N-Acetyl-β-D-Glucosaminidase and γ-Glutamyl Transpeptidase Activities in Clinically Normal Adult Dogs,” American Journal of Veterinary Research 70, no. 2 (February 2009): 297–301.
10.2460/ajvr.70.2.297
CAS PubMed Web of Science® Google Scholar

Volume106, Issue1

July 1, 2025

Pages 269-276

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Profiling of Diagnostic Value of Serum CysC, β2-MG and α-Klotho in Early Acute Kidney Injury Caused by Acute Myocardial Infarction

ABSTRACT

Objective

Methods

Results

Conclusion

Conflicts of Interest

Open Research

Data Availability Statement

References

References

Information

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Profiling of Diagnostic Value of Serum CysC, β2-MG and α-Klotho in Early Acute Kidney Injury Caused by Acute Myocardial Infarction

ABSTRACT

Objective

Methods

Results

Conclusion

Conflicts of Interest

Open Research

Data Availability Statement

References

References

Related

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