Use of Biomarkers to Assess Prognosis and Guide Management of Patients with Acute Kidney Injury

Abstract

Several new biomarkers of kidney damage have been characterized and are being validated in clinical studies. These damage biomarkers complement existing conventional biomarkers of kidney function (e.g. serum creatinine, serum urea, and urine output) that are currently utilized to diagnose and stage acute kidney injury (AKI). Both functional and damage biomarkers provide an opportunity to identify patients with AKI who are at risk for a less favorable prognosis in terms of worsening damage or further declines in kidney function and likelihood of need for renal replacement. We performed a systemic search and review of the available literature pre-conference. Our workgroup presented the findings in multiple rounds to the ADQI conference members and a final summary and review was refined in an iterative approach. The specific clinical situations of renal or liver transplantation, or cirrhosis/hepatorenal syndrome were not included. Overall, multiple AKI biomarkers have been well characterized for utilization for AKI prognosis. These functional and damage markers can be used to assist in decisions related to triage of patients with AKI and identifying patients with who are at risk for progression. Set cut-offs for various biomarkers and their bedside utility are forthcoming and will be in part determined by regulatory intended use guidelines, platform standardization, and inter-laboratory calibration. There remain many unresolved areas of AKI biomarker use in selected syndromes of AKI (e.g. cardiorenal syndrome, hepatorenal syndrome). As clinicians gain experience with AKI biomarkers, clinical care plans that incorporate them into routine care will shortly follow.

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

“…Many investigators have examined various patient populations and determined the performance of NGAL. Its performance has been evaluated in various settings, such as for prediction of AKI in pediatric [22] and adult cardiac surgery patients [72,76], in critically ill patients [8,24], in patients in the emergency department [20,21], and in patients in the kidney transplant setting [77][78][79]. A recent meta-analysis by Ho et al including 16 studies with a total of 2906 patients investigated urine NGAL as a biomarker for the prediction of AKI after cardiac surgery in adult patients.…”

“…Despite recent medical progress, the incidence of AKI continues to rise among patients who are hospitalized or admitted to an intensive care unit (ICU) [7,8]. However, with implementation of better preventive strategies, the mortality of patients who develop AKI in the ICU appears to be on a downward trajectory [9].…”

“…However, with implementation of better preventive strategies, the mortality of patients who develop AKI in the ICU appears to be on a downward trajectory [9]. Timely identification of AKI and appropriate implementation of preventive strategies are thought to be the most effective tools to improve AKI outcomes [8,10].…”

“…Biomarkers of AKI have the ability to identify the injury to the tubular system and to earlier identify patients who are going to develop AKI [8,10]. Furthermore, biomarkers 0.…”

Cell Cycle Arrest Biomarkers: New Weapons for A New Battle

“…In spite of a growing body of publications, many new biomarkers have not yet transitioned to clinical routine because of a series of unresolved issues [3]. The first is the lack of specificity for AKI of some molecules.…”