Use of tissue inhibitor of metalloproteinase 2 and insulin-like growth factor binding protein 7 [TIMP2]•[IGFBP7] as an AKI risk screening tool to manage patients in the real-world setting

Kane‐Gill, Sandra L.; Peerapornratana, Sadudee; Wong, Adrian; Murugan, Raghavan; Groetzinger, Lara; Kim, Catherine; Smithburger, Pamela L.; Then, Janine; Kellum, John A.

doi:10.1016/j.jcrc.2020.02.002

Cited by 18 publications

(14 citation statements)

References 29 publications

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“…Experts from Europe and North America have recommended many of the interventions proposed in LAPIS trial guided by the results of [TIMP-2]•[IGFBP7] ( 24 ). KDIGO bundles applied after interpreting the results of [TIMP-2]•[IGFBP7] seem to be effective in reducing AKI both in real-life ( 25 ) and in clinical trials settings ( 18 , 19 , 26 ). In particular, nephrotoxic exposure (e.g., vancomycin, piperacillin/tazobactam, nonsteroidal anti-inflammatory drugs, radiocontrast agents) is known to be frequent in ICU patients and may lead to drug-associated AKI in around 15–25% of the patients ( 27 ).…”

Section: Discussionmentioning

confidence: 99%

Limiting Acute Kidney Injury Progression In Sepsis: Study Protocol and Trial Simulation*

Molinari

Heskia

Peerapornratana

et al. 2021

Critical Care Medicine

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Section: Discussionmentioning

confidence: 99%

Limiting Acute Kidney Injury Progression In Sepsis: Study Protocol and Trial Simulation*

Molinari

Heskia

Peerapornratana

et al. 2021

Critical Care Medicine

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“…The content of the used AKI care bundles varied largely; components of each bundle are described in Table 2. The KDIGO bundle was most frequently used [ 8 , 20 , 22 , 26 , 30 , 32 , 35 ], often in association with biomarker-guided strategies. There was a high variability in overall compliance to the care bundle, ranging from 8 to 100%.…”

Section: Resultsmentioning

confidence: 99%

Impact of AKI care bundles on kidney and patient outcomes in hospitalized patients: a systematic review and meta-analysis

et al. 2021

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Background A bundle of preventive measures can be taken to avoid acute kidney injury (AKI) or progression of AKI. We performed a systematic review and meta-analysis to evaluate the compliance to AKI care bundles in hospitalized patients and its impact on kidney and patient outcomes. Methods Randomized controlled trials, observational and interventional studies were included. Studied outcomes were care bundle compliance, occurrence of AKI and moderate-severe AKI, use of kidney replacement therapy (KRT), kidney recovery, mortality (ICU, in-hospital and 30-day) and length-of-stay (ICU, hospital). The search engines PubMed, Embase and Google Scholar were used (January 1, 2012 - June 30, 2021). Meta-analysis was performed with the Mantel Haenszel test (risk ratio) and inverse variance (mean difference). Bias was assessed by the Cochrane risk of bias tool (RCT) and the NIH study quality tool (non-RCT). Results We included 23 papers of which 13 were used for quantitative analysis (4 RCT and 9 non-randomized studies with 25,776 patients and 30,276 AKI episodes). Six were performed in ICU setting. The number of trials pooled per outcome was low. There was a high variability in care bundle compliance (8 to 100%). Moderate-severe AKI was less frequent after bundle implementation [RR 0.78, 95%CI 0.62–0.97]. AKI occurrence and KRT use did not differ between the groups [resp RR 0.90, 95%CI 0.76–1.05; RR 0.67, 95%CI 0.38–1.19]. In-hospital and 30-day mortality was lower in AKI patients exposed to a care bundle [resp RR 0.81, 95%CI 0.73–0.90, RR 0.95 95%CI 0.90–0.99]; this could not be confirmed by randomized trials. Hospital length-of-stay was similar in both groups [MD -0.65, 95%CI -1.40,0.09]. Conclusion This systematic review and meta-analysis shows that implementation of AKI care bundles in hospitalized patients reduces moderate-severe AKI. This result is mainly driven by studies performed in ICU setting. Lack of data and heterogeneity in study design impede drawing firm conclusions about patient outcomes. Moreover, compliance to AKI care bundles in hospitalized patients is highly variable. Additional research in targeted patient groups at risk for moderate-severe AKI with correct and complete implementation of a feasible, well-tailored AKI care bundle is warranted. (CRD42020207523).

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“…If a patient is at risk for moderate to severe AKI based on the assay results, the pharmacist should evaluate all potentially nephrotoxic medications for discontinuation or dosage adjustment as one component of the recommended KDIGO care bundle. 40 Additionally, the pharmacist needs to consider dose adjustments of all renally eliminated medications if there is AKI progression. However, the pharmacist should recognize that a substantial number of patients have transient AKI that reverses within several days, which could lead to subtherapeutic medication concentrations with overly aggressive dose reductions and inadequate monitoring.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of the Biomarker TIMP-2•IGFBP7 for Acute Kidney Injury Assessment in Critically Ill Patients: A Narrative Review

Erstad

2021

Ann Pharmacother

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Objectives: To review the clinical usefulness of the biomarker TIMP-2•IGFBP7 in adult, general medical-surgical intensive care unit (ICU) settings. Data Sources: PubMed (1946 to mid-February 2021) and EMBASE (1947 to mid-February 2021) with bibliographies of retrieved articles reviewed for additional articles. Study Selection and Data Extraction: Studies evaluating use of the urinary TIMP-2•IGFBP7 assay in adult patients in ICU settings. Data Synthesis: Studies published after investigations leading to TIMP-2•IGFBP7 assay approval confirm the appropriateness of considerations discussed in product labeling, such as use of the test within 12 hours of assessment, use of a dichotomous 0.3 (ng/mL)2/1000 cutoff, and use only in combination with other assessments of acute kidney injury (AKI). However, as a biomarker routinely used for early identification of patients at risk for AKI in mixed ICU populations, the additional resources required for TIMP-2•IGFBP monitoring are difficult to justify because of limited data demonstrating usefulness in preventing or ameliorating AKI and its attendant complications. Relevance to Patient Care and Clinical Practice: Biomarkers are potentially useful not only for assessment and diagnosis of AKI, but also for practitioners involved in the management of nephrotoxic medications and medications needing adjustment for decreased kidney function. Conclusions: Although there is evidence to suggest that the urinary TIMP-2•IGFBP7 biomarker is helpful in predicting AKI progression in general medical-surgical ICU patients when used within 12 hours of patient assessment in combination with routine testing, including serum creatinine and urine output, there is little evidence that its use leads to improvements in clinically important patient outcomes.

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Use of tissue inhibitor of metalloproteinase 2 and insulin-like growth factor binding protein 7 [TIMP2]•[IGFBP7] as an AKI risk screening tool to manage patients in the real-world setting

Cited by 18 publications

References 29 publications

Limiting Acute Kidney Injury Progression In Sepsis: Study Protocol and Trial Simulation*

Limiting Acute Kidney Injury Progression In Sepsis: Study Protocol and Trial Simulation*

Impact of AKI care bundles on kidney and patient outcomes in hospitalized patients: a systematic review and meta-analysis

Usefulness of the Biomarker TIMP-2•IGFBP7 for Acute Kidney Injury Assessment in Critically Ill Patients: A Narrative Review

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