Evaluation of Dickkopf-3 in acute kidney injury in patients undergoing coronary angiography: A pilot study

Introduction: Urinary dickkopf-3 (DKK3), which is a kidney tubular stress marker has been suggested recently for preoperative identification ofpatients at risk ofacute kidney injury. We aimed to assess the predictive role of urinary DKK3/creatinine (Cr) ratio in contrast-induced nephropathy (CIN) in patients undergoing percutaneous coronary intervention (PC1). Methods: This prospective observational study included patients undergoing elective PCI. The association between the ratio of precontrast urinary concentrations of DKK3/Cr and post contrast CIN was evaluated. The serum Cr, urinary DKK3 and Cr levels of the patients were measured before and after contrast media administration, and the sensitivity of urinary DKK3/Cr ratio in diagnosing CIN in the early stage was assessed by the area under receiver operating characteristic curve. Results: A total of 44 patients (33 males) undergoing PCI were enrolled and mean age of the patients was 61.5 +/- 10.0 years. 22.7% of the patients developed CIN, none of them received hemodialysis during hospitalization. The mean urinary DKK3/Cr ratio was 950 +/- 491 pg/mg in the CIN patients versus 386 +/- 272 pg/mg in the non- CIN patients before contrast media administration (p=0.001). The mean urinary DKK3/Cr ratio was 1266 +/- 738 pg/mg in the CIN patients versus 305 +/- 192 pg/mg in the non- CIN patients at 12th hour after contrast media infusion (p<0.001). The roc-curve for the urinary DKK3/Cr ratio before contrast administration (AUC=0.835, p=0.001). Conclusions: Pre-contrast urinary DKK3/Cr ratio is a predictor for CIN. Urinary DKK3/Cr ratio may help in the identification of patients who are at risk of CIN.