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Subclinical AKI: ready for primetime in clinical practice?
Jill Vanmassenhove1, Wim Van Biesen1, Raymond Vanholder1
1Renal Division, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
Journal of Nephrology
|December 8, 2018
Summary
Standardized acute kidney injury (AKI) definitions exist, but rely on imperfect measures. New biomarkers show promise for earlier detection and improved outcomes, though their clinical utility requires further evaluation.
Area of Science:
- Nephrology
- Biomarker Research
- Clinical Diagnostics
Background:
- Established acute kidney injury (AKI) classification criteria (RIFLE, AKIN, KDIGO, ERBP) have limitations due to reliance on serum creatinine and urinary output.
- Current diagnostic parameters for AKI may not allow for timely diagnosis, potentially impacting patient outcomes.
- The search for novel biomarkers indicating structural tubular damage is ongoing, with debate surrounding their integration into existing classification systems.
Purpose of the Study:
- To provide a framework for critically appraising research on AKI biomarkers.
- To discuss the positioning and clinical relevance of the concept of subclinical AKI.
- To guide the evaluation of biomarker performance and the utility of subclinical AKI in various clinical and research contexts.
Main Methods:
- Review of existing literature on AKI classification criteria and biomarker research.
- Analysis of the concept of subclinical AKI, defined by biomarker elevation without overt clinical signs.
- Discussion on the critical appraisal of biomarker research, considering performance, context, and goals (risk assessment, prediction, diagnosis, prognostication).
Main Results:
- Current AKI classification criteria are imperfect, necessitating exploration of new diagnostic tools.
- Novel biomarkers may enable earlier AKI detection and potentially improve patient outcomes.
- The clinical relevance of elevated biomarkers without functional repercussions (subclinical AKI) remains undetermined.
Conclusions:
- The evaluation of new AKI biomarkers and the concept of subclinical AKI requires careful consideration of the intended application and desired outcomes.
- Further research is needed to determine if biomarkers, particularly in the context of subclinical AKI, improve patient outcomes when incorporated into classification criteria.
- Context-specific evaluation of biomarker performance is crucial for advancing AKI diagnosis and management.
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