Proenkephalin A als Biomarker zur Steuerung der Nierenersatztherapie bei Intensivpatienten - eine prospektive Beobachtungsstudie

Proenkephalin as a guide to cessation of renal replacement therapy in the ICU - a prospective observational study

by Paulina Marie Brandes
Doctoral thesis
Date of Examination:2025-08-21
Date of issue:2025-08-21
Advisor:PD Dr. Martin Sebastian Winkler
Referee:PD Dr. Martin Sebastian Winkler
Referee:Prof. Dr. Manuel Wallbach
Persistent Address: http://dx.doi.org/10.53846/goediss-11458

 

 

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Abstract

English

Acute Kidney Injury (AKI) represents a significant and frequent health concern within intensive care units (ICU), with an incidence rate ranging from 20% to 50% (Hoste et al. 2015; Susantitaphong et al. 2013). AKI often correlates with electrolyte imbalances, hypervolemia, and other complications, contributing to increased morbidity and mortality rates (Kidney Disease: Improving Global et al. 2012). Whilst the definition of AKI, primarily based on serum creatinine (SCr) and diuresis, and the criteria to indicate the need for dialysis are stated in several quidelines, criteria for discontinuation of the dialysis remain uncertain. Thus, there is a dire need for more effective diagnostic and prognostic tools in the management of AKI to enable early intervention and enhance patient outcomes. Proenkephalin (PENK), a biomarker currently under investigation, has shown promising results in its ability to predict AKI, particularly in ICU patients undergoing dialysis (Kim et al. 2017; Kim et al. 2020). This dissertation investigated whether PENK is associated with the established kidney parameters, the severity of AKI and the development of kidney function within patients undergoing dialysis. The results show an unhomogenous correlation of PENK and the established kidney parameters at the start and throughout the renal replacement therapy. Also, the dynamics of PENK don't correlate with the dynamics of the established kidney parameters significantly. In this cohort, PENK was unable to predict neither the success of a discontinuation from dialyses nor the survival rate. PENK however was able to imply subgroups of AKI patients at the start of dialysis. Furthermore, PENK did indicate a dynamic under dialysis that the established kidney parameters were not able to track.
Keywords: acute kidney injury; renal replacement therapy; ards; sepsis; biomarker
 
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