Precision management of acute kidney injury in the intensive care unit: current state of the art

Stanski, Natalja L.; Rodrigues, C.; Strader, Michael Brad; Murray, Patrick; Endre, Zoltán H.; Bagshaw, Sean M.

doi:10.1007/s00134-023-07171-z

Cited by 17 publications

(9 citation statements)

References 85 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…An elevated urinary [TIMP2]•[IGFBP7]-a marker for cell-cycle arrest, predicts AKI after cardiac surgery and non-cardiac surgery. 6 Specific biomarkers for kidney tubular injury-neutrophil gelatinaseassociated lipocalin (NGAL), kidney injury molecule 1 (KIM-1), and α-glutathione s-transferase (GST) and π-GST-can be detected prior to changes in serum creatinine and can predict AKI progression and severity. 6 NGAL is available as a point of care test allowing for rapid identification of AKI.…”

Section: Diagnosis and Classification Of Akimentioning

confidence: 99%

Failing kidneys: renal replacement therapies in the ICU

Patel,

Egodage

2024

Trauma Surg Acute Care Open

View full text Add to dashboard Cite

Acute kidney injury (AKI) is one of the most common organ dysfunctions impacting ICU (intensive care unit) patients. Early diagnosis using the various classification systems and interventions that can be aided by use of biomarkers are key in improving outcomes. Once the patient meets criteria of AKI, many patient specific factors determine the optimal timing for and mode of renal replacement therapy. There are several special considerations in surgical ICU patients with AKI including management of intracranial hypertension in those with cerebral edema, anticoagulation in high-risk bleeding patients, and use of contrast imaging. This article provides a focused review of the essential aspects of diagnosis and management of AKI in the critically ill or injured surgical patient.

show abstract

Section: Diagnosis and Classification Of Akimentioning

confidence: 99%

Failing kidneys: renal replacement therapies in the ICU

Patel,

Egodage

2024

Trauma Surg Acute Care Open

View full text Add to dashboard Cite

show abstract

“…A subgroup analysis in clinical research identifies patterns and subtypes within a diverse patient population, providing valuable insights for tailored treatment strategies [ 8 ]. Such an approach is particularly relevant in the era of precision medicine, where individual patient characteristics and disease subtypes are increasingly guiding treatment decisions [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Deciphering AKI in Burn Patients: Correlations between Clinical Clusters and Biomarkers

Lee,

Kym,

Yoon

et al. 2024

IJMS

View full text Add to dashboard Cite

Acute kidney injury (AKI) is a significant complication in burn patients, impacting outcomes substantially. This study explores the heterogeneity of AKI in burn patients by analyzing creatinine time-series data to identify distinct AKI clusters and evaluating routine biomarkers’ predictive values. A retrospective cohort analysis was performed on 2608 adult burn patients admitted to Hangang Sacred Heart Hospital’s Burn Intensive Care Unit (BICU) from July 2010 to December 2022. Patients were divided into four clusters based on creatinine trajectories, ranging from high-risk, severe cases to lower-risk, short-term care cases. Cluster A, characterized by high-risk, severe cases, showed the highest mortality and severity, with significant predictors being PT and TB. Cluster B, representing intermediate recovery cases, highlighted PT and albumin as useful predictors. Cluster C, a low-risk, high-resilience group, demonstrated predictive values for cystatin C and eGFR cys. Cluster D, comprising lower-risk, short-term care patients, indicated the importance of PT and lactate. Key biomarkers, including albumin, prothrombin time (PT), cystatin C, eGFR cys, and total bilirubin (TB), were identified as significant predictors of AKI development, varying across clusters. Diagnostic accuracy was assessed using area under the curve (AUC) metrics, reclassification metrics (NRI and IDI), and decision curve analysis. Cystatin C and eGFR cys consistently provided significant predictive value over creatinine, with AUC values significantly higher (p < 0.05) in each cluster. This study highlights the need for a tailored, biomarker-driven approach to AKI management in burn patients, advocating for the integration of diverse biomarkers in clinical practice to facilitate personalized treatment strategies. Future research should validate these biomarkers prospectively to confirm their clinical utility.

show abstract

“…Description of the terminology used in precision medicine, adapted from Seymour et al[64] and Stanski et al[65] …”

mentioning

confidence: 99%

Sepsis-associated acute kidney injury: recent advances in enrichment strategies, sub-phenotyping and clinical trials

Legrand,

Bagshaw,

Bhatraju

et al. 2024

Crit Care

Self Cite

View full text Add to dashboard Cite

Acute kidney injury (AKI) often complicates sepsis and is associated with high morbidity and mortality. In recent years, several important clinical trials have improved our understanding of sepsis-associated AKI (SA-AKI) and impacted clinical care. Advances in sub-phenotyping of sepsis and AKI and clinical trial design offer unprecedented opportunities to fill gaps in knowledge and generate better evidence for improving the outcome of critically ill patients with SA-AKI. In this manuscript, we review the recent literature of clinical trials in sepsis with focus on studies that explore SA-AKI as a primary or secondary outcome. We discuss lessons learned and potential opportunities to improve the design of clinical trials and generate actionable evidence in future research. We specifically discuss the role of enrichment strategies to target populations that are most likely to derive benefit and the importance of patient-centered clinical trial endpoints and appropriate trial designs with the aim to provide guidance in designing future trials.

show abstract

Precision management of acute kidney injury in the intensive care unit: current state of the art

Cited by 17 publications

References 85 publications

Failing kidneys: renal replacement therapies in the ICU

Failing kidneys: renal replacement therapies in the ICU

Deciphering AKI in Burn Patients: Correlations between Clinical Clusters and Biomarkers

Sepsis-associated acute kidney injury: recent advances in enrichment strategies, sub-phenotyping and clinical trials

Contact Info

Product

Resources

About