Assessment of Kidney Function and Osteomuscular Status After Critical Care

Study Overview
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Brief Summary
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This observational study aims to assess kidney function through direct glomerular filtration rate (GFR) using iohexol clearance, compared to estimated GFR based on creatinine and cystatin C equations. Kidney function will also be evaluated through renal fibrosis biomarkers. Kidney function will be correlated to body composition, muscle turnover biomarkers, and bone micro-architecture.

Detailed Description
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The investigators developed a post-ICU clinic where complications of the post-intensive care syndrome are detected. Muscle function is assessed by clinical testings, muscle strength measurement. Body composition is measured by electrical bioimpedance. Bone mass is assessed using dual-energy radiographic absorptiometry. It is well known that ICU survivors experience a loss of muscle mass. This can lead to misinterpretation of estimated GFR based on creatinine equations. The aim of the present study is to assess the evolution of kidney function after a prolonged stay in ICU, using GFR equations based on cystatin C, and to compare it to measured GFR using iohexol clearance. The second aim is to explore the evolution of bone and muscle health in these patients.

Official Title
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Assessment of Kidney Function and Osteomuscular Status in Survivors of a Prolonged Stay in Intensive Care Unit

Conditions
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Bone Loss, Critical Illness, Kidney Injury, Muscle Loss

Intervention / Treatment
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* Other: one-year follow-up


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: patients surviving an ICU stay of at least 7 days patients who experienced acute kidney injury (KDIGO criteria) during ICU stay Exclusion Criteria: chronic kidney injury with dedicated follow-up before ICU admission chronic extrarenal epuration kidney transplant allergy to iohexol iodinated contrast allergy refusal

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Post-ICU group<br>Observational foolow-up | Other: one-year follow-up<br>* patients will be followed during the year after ICU discharge, in order to assess kidney function, and muscle and bone health<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| measured GFR | plasma clearance of iohexol | between day 0 and day 7 after ICU discharge | 
| measured GFR | plasma clearance of iohexol | at 3 months after ICU discharge | 
| measured GFR | plasma clearance of iohexol | at 12 months after ICU discharge | 
| estimated GFR | cystatin C based CKD-EPI equation | between day 0 and day 7 after ICU discharge | 
| estimated GFR | cystatin C based CKD-EPI equation | at 3 months after ICU discharge | 
| estimated GFR | cystatin C based CKD-EPI equation | at 12 months after ICU discharge | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| urine concentration of renal fibrose biomarkers | urine measurement of TGF-β concentration | between day 0 and day 7 after ICU discharge | 
| urine concentration of renal fibrose biomarkers | urine measurement of TGF-β concentration | at 3 months after ICU discharge | 
| urine concentration of renal fibrose biomarkers | urine measurement of TGF-β concentration | at 12 months after ICU discharge | 
| urine concentration of renal fibrose biomarkers | urine measurement of monocyte chemoattractant protein-1 concentration | between day 0 and day 7 after ICU discharge | 
| urine concentration of renal fibrose biomarkers | urine measurement of monocyte chemoattractant protein-1 concentration | at 3 months after ICU discharge | 
| urine concentration of renal fibrose biomarkers | urine measurement of monocyte chemoattractant protein-1 concentration | at 12 months after ICU discharge | 
| urine concentration of renal fibrose biomarkers | urine measurement of matrix metalloproteinases concentration | between day 0 and day 7 after ICU discharge | 
| urine concentration of renal fibrose biomarkers | urine measurement of matrix metalloproteinases concentration | at 3 months after ICU discharge | 
| urine concentration of renal fibrose biomarkers | urine measurement of matrix metalloproteinases concentration | at 12 months after ICU discharge | 
| urine concentration of renal fibrose biomarkers | urine measurement of chemokine ligands concentration | between day 0 and day 7 after ICU discharge | 
| urine concentration of renal fibrose biomarkers | urine measurement of chemokine ligands concentration | at 3 months after ICU discharge | 
| urine concentration of renal fibrose biomarkers | urine measurement of chemokine ligands concentration | at 12 months after ICU discharge | 
| urine concentration of renal fibrose biomarkers | urine measurement of C-X-C motif chemokine ligand concentration | between day 0 and day 7 after ICU discharge | 
| urine concentration of renal fibrose biomarkers | urine measurement of C-X-C motif chemokine ligand concentration | at 3 months after ICU discharge | 
| urine concentration of renal fibrose biomarkers | urine measurement of C-X-C motif chemokine ligand concentration | at 12 months after ICU discharge | 
| urine concentration of renal fibrose biomarkers | measurement of proteinuria | between day 0 and day 7 after ICU discharge | 
| urine concentration of renal fibrose biomarkers | measurement of proteinuria | at 3 months after ICU discharge | 
| urine concentration of renal fibrose biomarkers | measurement of proteinuria | at 12 months after ICU discharge | 
| blood concentration of muscle turnover markers | blood measurement of myostatin concentration | between day 0 and day 7 after ICU discharge | 
| blood concentration of muscle turnover markers | blood measurement of myostatin concentration | at 3 months after ICU discharge | 
| blood concentration of muscle turnover markers | blood measurement of myostatin concentration | at 12 months after ICU discharge | 
| blood concentration of muscle turnover markers | blood measurement of procollagen type III N-terminal peptide (P3NP) concentration | between day 0 and day 7 after ICU discharge | 
| blood concentration of muscle turnover markers | blood measurement of procollagen type III N-terminal peptide (P3NP) concentration | at 3 months after ICU discharge | 
| blood concentration of muscle turnover markers | blood measurement of procollagen type III N-terminal peptide (P3NP) concentration | at 12 months after ICU discharge | 
| blood concentration of muscle turnover markers | blood measurement of insulin growth factor 1 concentration | between day 0 and day 7 after ICU discharge | 
| blood concentration of muscle turnover markers | blood measurement of insulin growth factor 1 concentration | at 3 months after ICU discharge | 
| blood concentration of muscle turnover markers | blood measurement of insulin growth factor 1 concentration | at 12 months after ICU discharge | 
| bone micro-architecture | high resolution peripheral quantitative computed tomography (HRpQCT) images acquisition | between day 0 and day 7 after ICU discharge | 
| bone micro-architecture | high resolution peripheral quantitative computed tomography (HRpQCT) images acquisition | at 3 months after ICU discharge | 
| bone micro-architecture | high resolution peripheral quantitative computed tomography (HRpQCT) images acquisition | at 12 months after ICU discharge |