Measuring glomerular filtration rate in the intensive care unit: no substitutes please

Molitoris, Bruce A.

doi:10.1186/cc12876

Cited by 21 publications

(11 citation statements)

References 13 publications

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“…The lower individual performance by the panel of biomarkers in this study is consistent with prior multicenter reports and may be due to many factors [5,[9][10][11][12][13][14][15][22][23][24][25][26]. The inconsistent performance of biomarkers across studies in critically ill adult patients can be explained by several factors, such as indiscriminate use of various biomarkers without knowledge of patient clinical status [25,27], heterogeneous patient population with unknown timing and etiology of AKI, lack of gold standard marker [28,29], presence of comorbid illness, in particular, CKD [22,30,31], the presence of volume overload and muscle wasting in critically ill patients and finally lack of clinical context and clinical recommendation on biomarker use [29,32]. The use of the clinical model for the future risk prediction of severe AKI, need of RRT and/or death noticeably increases the AUC without the use of any biomarkers despite the heterogeneous nature of our ICU population with multiple comorbid illnesses and presence of CKD.…”

Section: Discussionsupporting

confidence: 79%

Biomarker Predictors of Adverse Acute Kidney Injury Outcomes in Critically Ill Patients: The Dublin Acute Biomarker Group Evaluation Study

et al. 2019

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Background: The Dublin Acute Biomarker Group Evaluation (DAMAGE) Study is a prospective 2-center observational study investigating the utility of urinary biomarker combinations for the diagnostic and prognostic assessment of acute kidney injury (AKI) in a heterogeneous adult intensive care unit (ICU) population. The objective of this study is to evaluate whether serial urinary biomarker measurements, in combination with a simple clinical model, could improve biomarker performance in the diagnostic prediction of severe AKI and clinical outcomes such as death and need for renal replacement therapy (RRT). Methods: Urine was collected daily from patients admitted to the ICU, for a total of 7 post-admission days. Urine biomarker concentrations (neutrophil gelatinase-associated lipocalin [NGAL], α-glutathione S-transferase [GST], π-GST, kidney injury molecule-1 [KIM-1], liver-type fatty acid-binding protein [L-FABP], Cystatin C, creatinine, and albumin) were measured. Urine biomarkers were combined with a clinical prediction of AKI model, to determine ability to predict AKI (any stage, within 2 days or 7 days of ICU admission), or a 30-day composite clinical outcome (RRT – or death). Results: A total of 257 (38%) patients developed AKI within 7 days of ICU admission. Of those who developed AKI, 106 (41%) patients met stage 3 AKI within 7 days of ICU admission and 208 patients of the entire study cohort (31%) met the composite clinical endpoint of in-hospital mortality or RRT within 30 days of ICU admission. The addition of urinary NGAL/albumin to the clinical model modestly improved the prediction of AKI, in particular severe stage 3 AKI (area under the curve [AUC] of 0.9 from 0.87, p = 0.369) and the prediction of 30-day RRT or death (AUC 0.83 from 0.79, p = 0.139). Conclusion: A clinical model incorporating severity of illness, patient demographics, and chronic illness with currently available clinical biomarkers of renal function was strongly predictive of development of AKI and associated clinical outcomes in a heterogeneous adult ICU population. The addition of urinary NGAL/albumin to this simple clinical model improved the prediction of severe AKI, need for RRT and death, but not at a statistically or clinically significant level, when compared to the clinical model alone.

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Section: Discussionsupporting

confidence: 79%

Biomarker Predictors of Adverse Acute Kidney Injury Outcomes in Critically Ill Patients: The Dublin Acute Biomarker Group Evaluation Study

et al. 2019

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“…Cost-effectiveness analysis is one of the first steps in the clinical implementation of AKI biomarkers. Health technology assessment is a multidisciplinary process that could provide an appropriate platform for such analysis [188,189]. The cost of research and development, along with the clinical application of such biomarkers, could be justified by the downstream savings achieved by avoiding the need for long-term dialysis.…”

Section: Clinical Adoption Of Aki Biomarkersmentioning

confidence: 99%

Biomarkers of acute kidney injury: the pathway from discovery to clinical adoption

Kashani

Cheungpasitporn

Ronco

2017

Clinical Chemistry and Laboratory Medicine (CCLM)

244

197

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Acute kidney injury (AKI) is a common complication of critical illnesses and has a significant impact on outcomes, including mortality and morbidities. Unfortunately, apart from prophylactic measures, no effective treatment for this syndrome is known. Therefore, early recognition of AKI not only can provide better opportunities for preventive interventions, but also opens many gates for research and development of effective therapeutic options. Over the last few years, several new AKI biomarkers have been discovered and validated to improve early detection, differential diagnosis, and differentiation of patients into risk groups for progressive renal failure, need for renal replacement therapy (RRT), or death. These novel AKI biomarkers complement serum creatinine (SCr) and urine output, which are the standard diagnostic tools for AKI detection. In this article, we review the available literature on characteristics of promising AKI biomarkers that are currently the focus of preclinical and clinical investigations. These biomarkers include neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule 1 (KIM-1), liver-type fatty acid-binding protein, interleukin 18 (lL-18), insulin-like growth factor-binding protein 7, tissue inhibitor of metalloproteinase 2 (TIMP-2), calprotectin, urine angiotensinogen (AGT), and urine microRNA. We then describe the clinical performance of these biomarkers for diagnosis and prognostication. We also appraise each AKI biomarker's advantages and limitations as a tool for early AKI recognition and prediction of clinical outcomes after AKI. Finally, we review the current and future states of implementation of biomarkers in the clinical practice.

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“…However, such monitoring is possible and several investigators are working on the development of rapid, sensitive and affordable techniques to measure GFR in real time in routine clinical practice [34] . Knowing the actual GFR on a moment-tomoment basis might not only detect AKI earlier but also allow better monitoring and possibly, identification of patients in whom RRT should be considered.…”

Section: Non-aki Indications For Crrtmentioning

confidence: 99%

Patient Selection and Timing of Continuous Renal Replacement Therapy

et al. 2016

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When and in whom to initiate continuous renal replacement therapy (CRRT) for acute kidney injury (AKI) remains a highly controversial topic with large practice variation around the world. Even within countries, practice variation exists and recommendations for clinical practice are not specific. In this article, we report the consensus recommendations for timing and patient selection for CRRT - the results of the 2016 Acute Disease Quality Initiative XVII conference on ‘precision CRRT'. We suggest that these recommendations could serve to develop the best clinical practice and standards of care for use of CRRT in patients with AKI. Finally, we identify and highlight the areas of ongoing uncertainty and propose an agenda for future research.

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Measuring glomerular filtration rate in the intensive care unit: no substitutes please

Cited by 21 publications

References 13 publications

Biomarker Predictors of Adverse Acute Kidney Injury Outcomes in Critically Ill Patients: The Dublin Acute Biomarker Group Evaluation Study

Biomarker Predictors of Adverse Acute Kidney Injury Outcomes in Critically Ill Patients: The Dublin Acute Biomarker Group Evaluation Study

Biomarkers of acute kidney injury: the pathway from discovery to clinical adoption

Patient Selection and Timing of Continuous Renal Replacement Therapy

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