Potential use of biomarkers in acute kidney injury: report and summary of recommendations from the 10th Acute Dialysis Quality Initiative consensus conference

Abstract

Over the last decade there has been considerable progress in the discovery and development of biomarkers of kidney disease, and several have now been evaluated in different clinical settings. While there is a growing literature on the performance of various biomarkers in clinical studies, there is limited information on how these biomarkers would be utilized by clinicians to manage patients with acute kidney injury (AKI). Recognizing this gap in knowledge, we convened the 10th Acute Dialysis Quality Initiative (ADQI) meeting to review the literature on biomarkers in AKI and their application in clinical practice. We asked an international group of experts to assess four broad areas for biomarker utilization for AKI: risk assessment, diagnosis and staging; differential diagnosis; prognosis and management and novel physiological techniques including imaging. This article provides a summary of the key findings and recommendations of the group, to equip clinicians to effectively use biomarkers in AKI.

Acute kidney injury in the perioperative period and in intensive care units (excluding renal replacement therapies)

“…Currently, no curative strategies enable clinicians to treat such established damage, and AKI is clearly associated with an increased independent risk of in-hospital mortality and CRI within a few years following AKI [16][17][18][19][20][21]. Therefore, current data strongly suggest the need to research risk factors for AKI and to detect early kidney attack episodes [1,[22][23][24]. Consequently, over the last 10 years multiple renal biomarkers capable of detecting early acute kidney attacks have been developed.…”

Cellular and Molecular Mechanisms of AKI

“…This initiative should build on current efforts to use biomarkers of kidney damage to provide correlative evidence of efficacy (along with markers of renal function) in proofof-concept phase II trials, and to use such biomarkers to trigger early postinsult enrollment in future clinical trials (not successfully achieved to date). 82,83 Ideally, such predictive biomarkers should be validated to become companion diagnostics that can effectively personalize AKI therapy in clinical practice, matching susceptible patients with AKI with the correct mechanistically targeted therapy at the right time to target the precise phase of evolution of injury. As part of drug development, there should also be an iterative process from bedside back to bench to utilize results (both positive and negative) to help inform and develop more appropriate context-specific AKI models (Figure 2).…”

Clinical diagnostic algorithms of opioid dependence

“…В связи с тем, что биомаркеры отражают повреж-дение различных локусов нефрона, диагностика ОПП, когда его этиология по клинико-лаборатор-ным данным не совсем ясна, предопределила появ-ление исследований, оценивающих значение сразу нескольких биомаркеров [5,16,18,25,26,27,33,35,41]. В проспективном исследовании больных после кардиохирургческих вмешательств было показано, что наибольшей чувствительностью обладает ме-тод, который основывается на одновременном из-мерении концентрации NGAL, NAG и KIM-1 [11].…”