Published in:
01-12-2020 | Acute Kidney Injury | Letter
Endostatin shows a useful value for predicting failure to recover from acute kidney injury: some confounders to consider
Authors:
Patrick M. Honore, Christina David, Aude Mugisha, Rachid Attou, Sebastien Redant, Andrea Gallerani, David De Bels
Published in:
Critical Care
|
Issue 1/2020
Login to get access
Excerpt
Jia and colleagues have concluded that plasma endostatin shows a useful value for predicting failure to recover from acute kidney injury (AKI) [
1]. They studied two populations of patients with AKI following non-cardiac major surgery, with the primary endpoint of recovery or “non-recovery” from AKI. Patients classified as “non-recovery” from AKI in fact consisted of two groups, a cohort receiving renal replacement therapy (RRT) at day 7 and another cohort without RRT [
1]. We would like to make some comments. Endostatin, the C-terminal fragment of collagen XVIII, is a cytokine with a molecular weight of 20 kDa [
2]. It stands to reason that this small molecule can be easily removed by RRT as the cutoff point of filter membranes is about 35 kDa [
3]. According to the authors, patients with renal recovery showed endostatin concentrations of 62.6 ng/ml, whereas patients failing to recover showed higher concentrations of 108.5 ng/ml [
1]. Also, almost 20% of the AKI population received RRT for 7 days [
1]. Considering that endostatin can be removed by RRT, the endostatin values in this group of patients may fall significantly [
3]. This could give the clinician the false impression that the patient will recover from AKI. Accordingly, if endostatin is used as a predictive tool in the future, falsely low endostatin values in RRT patients could lead to a premature de-escalation of care for intensive care unit (ICU) patients. There has been no investigation of the performance of endostatin in patients who receive RRT. Therefore, we believe there is a critical need for a future study with a focus on the performance of the currently known sepsis biomarkers in patients who receive RRT [
4]. As noted by experts in endostatin, there is not enough evidence to date to support the use of endostatin measurements in clinical practice [
5]. RRT is a good example of one of those conditions [
5]. …