Recommendations on Acute Kidney Injury Biomarkers From the Acute Disease Quality Initiative Consensus Conference

Abstract

IMPORTANCE In the last decade, new biomarkers for acute kidney injury (AKI) have been identified and studied in clinical trials. Guidance is needed regarding how best to incorporate them into clinical practice. OBJECTIVE To develop recommendations on AKI biomarkers based on existing data and expert consensus for practicing clinicians and researchers. EVIDENCE REVIEW At the 23rd Acute Disease Quality Initiative meeting, a meeting of 23 international experts in critical care, nephrology, and related specialties, the panel focused on 4 broad areas, as follows: (1) AKI risk assessment; (2) AKI prediction and prevention; (3) AKI diagnosis, etiology, and management; and (4) AKI progression and kidney recovery. A literature search revealed more than 65 000 articles published between 1965 and May 2019. In a modified Delphi process, recommendations and consensus statements were developed based on existing data, with 90% agreement among panel members required for final adoption. Recommendations were graded using the Grading of Recommendations, Assessment, Development and Evaluations system. FINDINGS The panel developed 11 consensus statements for biomarker use and 14 research recommendations. The key suggestions were that a combination of damage and functional biomarkers, along with clinical information, be used to identify high-risk patient groups, improve the diagnostic accuracy of AKI, improve processes of care, and assist the management of AKI. CONCLUSIONS AND RELEVANCE Current evidence from clinical studies supports the use of new biomarkers in prevention and management of AKI. Substantial gaps in knowledge remain, and more research is necessary.

Toll-Like Receptors in Acute Kidney Injury

“…These novel biomarkers are related with pathological processes involved in AKI development, such as inflammation, oxidative stress and renal cells death [19,20]. Furthermore, current studies support the potential value of circulating and urinary miRNAs as novel AKI biomarkers e.g., miR-21, miR-30a-e and miR-494, among others [18,21,22].…”

“…In addition, many factors influence serum creatinine concentration e.g., age, gender, diet, muscle mass, and hydration status), limiting its utility as an AKI biomarker. For these reasons, there is a great interest in the search of new AKI biomarkers for early detection, differential diagnosis and prognosis [17,18]. In this context, the most promising AKI biomarkers are listed in Table 1.…”

Predictive value of plasma proenkephalin and neutrophil gelatinase-associated lipocalin in acute kidney injury and mortality in cardiogenic shock

“…AKI was defined and staged according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria [4]. For AKI staging at baseline, a recently described staging which includes biomarker levels was used [5]. Urine output was recorded at 6, 12, 18, and 24 h and used for urine output-based definitions of AKI.…”

“…Acute kidney injury (AKI) is a frequent form of organ injury in cardiogenic shock, affecting ~ 30% of patients surviving the initial stage [3]. Traditionally, serum creatinine and urine output are used to define AKI [4], but these markers are limited by delayed changes following kidney injury and have low sensitivity and specificity [5]. Prediction of AKI with biomarkers such as neutrophil gelatinase-associated lipocalin (NGAL) and proenkephalin (PENK) have been studied in critically ill patients [6,7], but similar studies among cardiogenic shock patients are lacking.…”

Association of plasma and urine NGAL with acute kidney injury after elective colorectal surgery: A cohort study

“…A recent expert consensus meeting recommended using validated AKI biomarkers to identify patient populations who may benefit from early interventions to improve outcomes [ 21 ]. Neutrophil gelatinase-associated lipocalin (NGAL) is one of the most extensively studied biomarkers for AKI.…”