Elevated levels of urinary dickkopf-3 (DKK3) prior to cardiac surgery independently predicts postoperative acute kidney injury (AKI) and subsequent loss of kidney function, new study findings suggest.

“Urinary DKK3 is an indicator of renal tubular stress that significantly improves prediction of AKI beyond the established clinical models and available biomarkers,” investigators Stefan J. Schunk, MD, of University Medical Center in Homburg, Germany, and colleagues wrote in a paper published in The Lancet. “Measurement of urinary DKK3 might therefore represent a pesonalised medicine approach in patients having cardiac surgery to detect patients at risk for AKI and subsequent kidney function loss, thereby allowing preventive strategies to be put in place.”

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In an observational study of 733 patients who underwent cardiac surgery, the team found that preoperative urinary DKK3 levels above 471 pg/mg creatinine were associated with significant 1.6-fold greater odds of AKI independent of baseline renal function compared with levels of 471 pg/mg or less.

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In addition, during a median follow-up of 820 days, patients with preoperative urinary DKK3 levels above 471 pg/mg creatinine, compared with lower levels, had significant 2-fold increased odds of persistently reduced estimated glomerular filtration rate below 60 mL/min/1.73 m2 and 2.6-fold increased odds of a persistent rise in serum creatinine above 0.5 mg/dL.


Schunk S, Zarbock A, Meersch M, et al. Association between urinary dickkopf-3, acute kidney injury, and subsequent loss of kidney function in patiens undergoing cardiac surgery: an observational cohort study. Lancet. 2019;394:488-496. doi: 10.1016/S0140-6736(19)30769-X