Eye on AKI - Are shifting trends the cue for a platform clinical trial?

Acute kidney injury (AKI) affects ∼10-15% of hospital admissions in high-income countries and is associated with morbidity, mortality, and costs. Despite this burden, targeted therapies remain lacking, and randomised controlled trials have been slow to accommodate precision medicine. We evaluated temporal changes in the composition of kidney-related basic science research and the implications for AKI treatment development.

We conducted a mapping review of kidney research publications indexed in EMBASE from 1 January 2013 to 31 December 2024. Publications were classified as basic science and further categorised as AKI-related, mechanistic, or therapeutic. Annual publication counts and proportions were summarised descriptively, and simple regression models were used to assess temporal trends.

Total kidney research output increased over time (r = 0.86, r² = 0.75, β1 = 1439.6, p < 0.001), while the proportion classified as basic science declined (r = -0.85, r² = 0.72, β1 = -0.21, p < 0.001). In contrast, the share of AKI-focused basic science rose markedly (r = 0.99, r² = 0.98, β1 = 0.54, p < 0.001), with substantial growth in mechanistic (r = 0.94, r² = 0.89, β1 = 0.88, p < 0.001) and therapeutic studies (r = 0.96, r² = 0.93, β1 = 0.96, p < 0.001).

Overall kidney research is expanding, with increasing emphasis on AKI discovery science and a growing mechanistic and therapeutic pipeline. These trends support investment in trial infrastructure-such as adaptive platform trials capable of testing multiple, biomarker-enriched therapies-to accelerate translation into clinical practice.