High renin levels may be a biomarker for worse outcomes in hospitalized patients with acute kidney injury (AKI), investigators reported at Kidney Week 2020 Reimagined, a virtual meeting sponsored by the American Society of Nephrology.

Victor M. Ortiz-Soriano, MD, of the University of Kentucky in Lexington, and colleagues analyzed data from blood samples obtained from critically ill patients in the KLAKI (Klotho and Acute Kidney Injury) study and patients undergoing cardiac surgery in the TRIBE-AKI (Translational Research Investigating Biomarker Endpoints in Acute Kidney Injury) study.

In the KLAKI study, renin levels were significantly higher among those who developed AKI than those who did not: median 67.9 vs 22.2 pg/mL (P <.001), Dr Ortiz-Soriano and colleagues reported. Similarly, among the cardiac surgery patients in the TRIBE-AKI study, the investigators observed significantly higher renin levels in patients with than without AKI: 157.9 vs 68.9 pg/mL on perioperative day 1 (P =.003).

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In adjusted models, higher renin levels independently associated with 38% increased odds of in-hospital mortality for every 1-unit increase in renin. Likewise, patients with the highest tertile of renin had 3.4-fold higher odds of death compared with those with the lowest tertile.

Furthermore, every 1-unit increase in renin increased the risk of major adverse kidney events (MAKE; a composite of death, need for renal replacement therapy, or inability to recover more than 75% of baseline estimated glomerular filtration rate) by 24%.

“Renin levels associate with hospital mortality and MAKE in critically ill patients and therefore its utility in risk-stratification should be further explored in this vulnerable population,” Dr Ortiz-Soriano’s team concluded.


Ortiz-Soriano VM, Gianella F, Flannery A, et al. Renin levels are higher in patients with AKI and associate with mortality and major adverse kidney events. Presented at: Kidney Week 2020 Reimagined, October 19-25, 2020. Poster PO0064.