Abstract
Acute Kidney Injury (AKI) following endovascular aortic repair (EVAR) is often diagnosed too late using conventional markers, limiting opportunities for timely intervention in this high-risk population. We investigated whether a mechanism-based biomarker panel could provide improved early AKI detection in EVAR patients. This prospective, single-center study enrolled 68 consecutive EVAR patients between April 2022 and June 2024. AKI was diagnosed using KDIGO 2012 criteria. Seven novel biomarkers, including Proenkephalin A 119-159 (penKid), Semaphorin-3A (SEMA-3A), Retinol Binding Protein-4 (RBP-4), Kidney Injury Molecule-1 (KIM-1), Netrin-1, Tissue Inhibitor of Metalloproteinases-2, and Insulin-Like Growth Factor Binding Protein-7, were measured at baseline, immediate postoperative, 24 h, and 48 h time points, and selected based on distinct nephron locations and release mechanisms. AKI occurred in 18 (26.5%) patients. Top-performing individual biomarkers included serum SEMA-3A (AUC 0.88), serum RBP-4 (AUC 0.81), and penKid (AUC 0.76). A three-biomarker panel combining serum penKid, serum SEMA-3A, and urinary KIM-1 achieved robust discriminatory performance (AUC 0.89, 95% CI 0.77-1.00), superior to individual biomarkers. An alternative panel with serum RBP-4 demonstrated comparable performance (AUC 0.81, 95% CI 0.65-0.99). Multi-biomarker panels combining functional, stress, and injury markers demonstrate promising performance for early AKI detection in EVAR patients. External validation in independent, multi-center cohorts is required before clinical implementation.