Recommendations on Acute Kidney Injury Biomarkers From the Acute Disease Quality Initiative Consensus Conference A Consensus Statement

被引：446

作者：

Ostermann, Marlies ^{[1
]}

Zarbock, Alexander ^{[2
]}

Goldstein, Stuart ^{[3
]}

Kashani, Kianoush ^{[4
,25
]}

Macedo, Etienne ^{[5
]}

Murugan, Raghavan ^{[6
]}

Bell, Max ^{[7
]}

Forni, Lui ^{[8
,26
]}

Guzzi, Louis ^{[9
]}

Joannidis, Michael ^{[10
]}

Kane-Gill, Sandra L. ^{[11
]}

Legrand, Mathieu ^{[12
]}

Mehta, Ravindra ^{[13
]}

Murray, Patrick T. ^{[14
]}

Pickkers, Peter ^{[15
]}

Plebani, Mario ^{[16
,17
]}

Prowle, John ^{[18
]}

Ricci, Zaccaria ^{[19
]}

Rimmele, Thomas ^{[20
]}

Rosner, Mitchell ^{[21
]}

Shaw, Andrew D. ^{[22
]}

Kellum, John A. ^{[6
]}

Ronco, Claudio ^{[23
,24
]}

机构：

[1] Kings Coll London, Guys & St Thomas Hosp, Dept Crit Care & Nephrol, London, England

[2] Univ Hosp Munster, Dept Anaesthesiol Intens Care Med & Pain Med, Munster, Germany

[3] Cincinnati Childrens Hosp Med Ctr, Ctr Acute Care Nephrol, Cincinnati, OH 45229 USA

[4] Mayo Clin, Dept Med, Div Pulm & Crit Care Med, Rochester, MN USA

[5] Univ Calif San Diego, Dept Med, Div Nephrol, San Diego, CA 92103 USA

[6] Univ Pittsburgh, Sch Med, Dept Crit Care Med, Ctr Crit Care Nephrol, Pittsburgh, PA USA

[7] Karolinska Univ Hosp, Dept Perioperat Med & Intens Care Med, Stockholm, Sweden

[8] Royal Surrey Hosp NHS Fdn Trust, Intens Care Unit, Surrey, England

[9] AdventHlth Waterman, Dept Crit Care Med, Orlando, FL USA

[10] Med Univ Innsbruck, Div Intens Care & Emergency Med, Innsbruck, Austria

[11] Univ Pittsburgh, Sch Pharm, Dept Pharm & Therapeut, Pittsburgh, PA 15261 USA

[12] Univ Calif San Francisco, Dept Anesthesia & Perioperat Care, San Francisco, CA 94143 USA

[13] Univ Calif San Diego, Dept Med, UCSD Med Ctr, San Diego, CA 92103 USA

[14] Univ Coll Dublin, Sch Med, Dublin, Ireland

[15] Radboud Univ Nijmegen, Nijmegen Med Ctr, Dept Intens Care Med, Nijmegen, Netherlands

[16] Univ Hosp Padova, Dept Lab Med, Padua, Italy

[17] Univ Padua, Dept Med DIMED, Padua, Italy

[18] Queen Mary Univ London, Royal London Hosp, William Harvey Res Inst, London, England

[19] Bambino Gesu Pediat Hosp, Ist Ricovero & Cura Carattere Sci, Pediat Cardiac Intens Care Unit, Rome, Italy

[20] Hop Edouard Herriot, Anesthesiol & Intens Care Med, Lyon, France

[21] Univ Virginia Hlth Syst, Div Nephrol, Charlottesville, VA USA

[22] Univ Alberta, Dept Anesthesiol & Pain Med, Edmonton, AB, Canada

[23] Univ Padua, Dept Med, Padua, Italy

[24] San Bortolo Hosp, Int Renal Res Inst, Dept Nephrol Dialysis & Transplantat, Vicenza, Italy

[25] Mayo Clin, Dept Med, Div Nephrol Hypertens, Rochester, MN USA

[26] Univ Surrey, Fac Hlth Sci, Dept Clin & Expt Med, Surrey, England

来源：

JAMA NETWORK OPEN | 2020年 / 3卷 / 10期

关键词：

RENAL REPLACEMENT THERAPY; CRITICALLY-ILL PATIENTS; DAMAGE BIOMARKERS; URINARY BIOMARKERS; TISSUE INHIBITOR; RISK; PREDICTION; DIALYSIS; PLASMA; AKI;

D O I：

10.1001/jamanetworkopen.2020.19209

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

This consensus statement develops recommendations on acute kidney injury biomarkers based on existing data and expert consensus for practicing clinicians and researchers. Importance In the last decade, new biomarkers for acute kidney injury (AKI) have been identified and studied in clinical trials. Guidance is needed regarding how best to incorporate them into clinical practice. Objective To develop recommendations on AKI biomarkers based on existing data and expert consensus for practicing clinicians and researchers. Evidence Review At the 23rd Acute Disease Quality Initiative meeting, a meeting of 23 international experts in critical care, nephrology, and related specialties, the panel focused on 4 broad areas, as follows: (1) AKI risk assessment; (2) AKI prediction and prevention; (3) AKI diagnosis, etiology, and management; and (4) AKI progression and kidney recovery. A literature search revealed more than 65000 articles published between 1965 and May 2019. In a modified Delphi process, recommendations and consensus statements were developed based on existing data, with 90% agreement among panel members required for final adoption. Recommendations were graded using the Grading of Recommendations, Assessment, Development and Evaluations system. Findings The panel developed 11 consensus statements for biomarker use and 14 research recommendations. The key suggestions were that a combination of damage and functional biomarkers, along with clinical information, be used to identify high-risk patient groups, improve the diagnostic accuracy of AKI, improve processes of care, and assist the management of AKI. Conclusions and Relevance Current evidence from clinical studies supports the use of new biomarkers in prevention and management of AKI. Substantial gaps in knowledge remain, and more research is necessary. Question How can new biomarkers for acute kidney injury be integrated into routine clinical practice? Findings In this consensus statement, a 23-expert panel developed 11 recommendations for the use of new stress, functional, and damage biomarkers in clinical practice to prevent and manage acute kidney injury. In addition, gaps in knowledge and areas for more research were identified. Meaning The integration of appropriately selected biomarkers in routine clinical practice has potential to improve acute kidney injury care.

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页数：17

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