NAD+ Biosynthesis Impairment and Acute Kidney Injury after Major Vascular Surgery
Acute kidney injury (AKI) is a serious complication after vascular surgery. Reduced synthesis of nicotinamide adenine dinucleotide (NAD+) from tryptophan is associated with an increased risk of AKI in critically ill patients, patients hospitalized with COVID-19, and cardiac surgery patients, and is...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2023-03-01
|
| Series: | Antioxidants |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2076-3921/12/4/821 |
| _version_ | 1797606646090825728 |
|---|---|
| author | Annmarie I. Mede Ginger L. Milne Dawei Wei Derek K. Smith Loren E. Smith |
| author_facet | Annmarie I. Mede Ginger L. Milne Dawei Wei Derek K. Smith Loren E. Smith |
| author_sort | Annmarie I. Mede |
| collection | DOAJ |
| description | Acute kidney injury (AKI) is a serious complication after vascular surgery. Reduced synthesis of nicotinamide adenine dinucleotide (NAD+) from tryptophan is associated with an increased risk of AKI in critically ill patients, patients hospitalized with COVID-19, and cardiac surgery patients, and is marked by elevated urinary quinolinate and quinolinate to tryptophan ratios. We measured quinolinate concentrations in vascular surgery patients to determine if impaired NAD+ synthesis was associated with AKI in this patient population. Eight preoperative and eight postoperative vascular surgery patients who developed AKI were selected from a parent study to participate in this single-center case-control study. They were matched with controls who did not develop AKI based on age, sex, BMI, eGFR, hypertension, and diabetes. Urinary quinolinate and tryptophan concentrations were measured at anesthetic induction and on postoperative day one. Two-sided Mann–Whitney U tests were used to compare quinolinate and quinolinate to tryptophan ratios. Multivariate linear regression modeling was used to estimate the relationship between quinolinate and serum creatinine. There was no difference in preoperative or postoperative urine quinolinate concentrations or the preoperative quinolinate to tryptophan ratio between patients that did and did not develop AKI (<i>p</i> = 0.07, 0.50, and 0.32, respectively). However, postoperative quinolinate to tryptophan ratios were higher in AKI patients (<i>p</i> = 0.04). Further, after adjustment for AKI risk factors, higher preoperative quinolinate concentrations and higher postoperative quinolinate to tryptophan ratios were associated with greater postoperative creatinine increases (<i>p</i> = 0.04 and 0.04, respectively). These data suggest that impaired NAD+ synthesis may contribute to AKI development in vascular surgery patients. |
| first_indexed | 2024-03-11T05:18:08Z |
| format | Article |
| id | doaj.art-93a62762f3fb42ca8434b50e7c68bc38 |
| institution | Directory Open Access Journal |
| issn | 2076-3921 |
| language | English |
| last_indexed | 2024-03-11T05:18:08Z |
| publishDate | 2023-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Antioxidants |
| spelling | doaj.art-93a62762f3fb42ca8434b50e7c68bc382023-11-17T18:04:46ZengMDPI AGAntioxidants2076-39212023-03-0112482110.3390/antiox12040821NAD+ Biosynthesis Impairment and Acute Kidney Injury after Major Vascular SurgeryAnnmarie I. Mede0Ginger L. Milne1Dawei Wei2Derek K. Smith3Loren E. Smith4Vanderbilt University School of Medicine, Nashville, TN 37232, USADepartments of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USADepartments of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USADepartments of Biostatistics, Vanderbilt University Medical Center, Nashville, TN 37232, USADepartments of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN 37232, USAAcute kidney injury (AKI) is a serious complication after vascular surgery. Reduced synthesis of nicotinamide adenine dinucleotide (NAD+) from tryptophan is associated with an increased risk of AKI in critically ill patients, patients hospitalized with COVID-19, and cardiac surgery patients, and is marked by elevated urinary quinolinate and quinolinate to tryptophan ratios. We measured quinolinate concentrations in vascular surgery patients to determine if impaired NAD+ synthesis was associated with AKI in this patient population. Eight preoperative and eight postoperative vascular surgery patients who developed AKI were selected from a parent study to participate in this single-center case-control study. They were matched with controls who did not develop AKI based on age, sex, BMI, eGFR, hypertension, and diabetes. Urinary quinolinate and tryptophan concentrations were measured at anesthetic induction and on postoperative day one. Two-sided Mann–Whitney U tests were used to compare quinolinate and quinolinate to tryptophan ratios. Multivariate linear regression modeling was used to estimate the relationship between quinolinate and serum creatinine. There was no difference in preoperative or postoperative urine quinolinate concentrations or the preoperative quinolinate to tryptophan ratio between patients that did and did not develop AKI (<i>p</i> = 0.07, 0.50, and 0.32, respectively). However, postoperative quinolinate to tryptophan ratios were higher in AKI patients (<i>p</i> = 0.04). Further, after adjustment for AKI risk factors, higher preoperative quinolinate concentrations and higher postoperative quinolinate to tryptophan ratios were associated with greater postoperative creatinine increases (<i>p</i> = 0.04 and 0.04, respectively). These data suggest that impaired NAD+ synthesis may contribute to AKI development in vascular surgery patients.https://www.mdpi.com/2076-3921/12/4/821AKIkidney injuryNADvascular surgeryquinolinate |
| spellingShingle | Annmarie I. Mede Ginger L. Milne Dawei Wei Derek K. Smith Loren E. Smith NAD+ Biosynthesis Impairment and Acute Kidney Injury after Major Vascular Surgery Antioxidants AKI kidney injury NAD vascular surgery quinolinate |
| title | NAD+ Biosynthesis Impairment and Acute Kidney Injury after Major Vascular Surgery |
| title_full | NAD+ Biosynthesis Impairment and Acute Kidney Injury after Major Vascular Surgery |
| title_fullStr | NAD+ Biosynthesis Impairment and Acute Kidney Injury after Major Vascular Surgery |
| title_full_unstemmed | NAD+ Biosynthesis Impairment and Acute Kidney Injury after Major Vascular Surgery |
| title_short | NAD+ Biosynthesis Impairment and Acute Kidney Injury after Major Vascular Surgery |
| title_sort | nad biosynthesis impairment and acute kidney injury after major vascular surgery |
| topic | AKI kidney injury NAD vascular surgery quinolinate |
| url | https://www.mdpi.com/2076-3921/12/4/821 |
| work_keys_str_mv | AT annmarieimede nadbiosynthesisimpairmentandacutekidneyinjuryaftermajorvascularsurgery AT gingerlmilne nadbiosynthesisimpairmentandacutekidneyinjuryaftermajorvascularsurgery AT daweiwei nadbiosynthesisimpairmentandacutekidneyinjuryaftermajorvascularsurgery AT derekksmith nadbiosynthesisimpairmentandacutekidneyinjuryaftermajorvascularsurgery AT lorenesmith nadbiosynthesisimpairmentandacutekidneyinjuryaftermajorvascularsurgery |