Image: The NephroCheck test is intended to assist the clinician in assessing the risk of moderate to severe acute kidney injury within the next 12 hours (Photo courtesy of Astute Medical).
Acute kidney injury (AKI) is a frequent complication among patients undergoing major surgery, and is known to increase morbidity, mortality risk, and costs. Although the complication can be managed, today’s standard indicators of AKI, such as elevated levels of serum creatinine, may not be present until kidney damage has already occurred.
The levels of two biomarkers increase in a patient’s urine in response to the earliest kidney cell stress, which can lead to AKI if left unmitigated. The two markers, usually elevated before serum creatinine, are involved in G1 cell-cycle arrest, a protective mechanism that prevents stressed cells from dividing in case of DNA damage. This allows the biomarkers to function as an early alarm of kidney cell stress before major damage and progression to AKI.
Medical scientists at the University Hospital Regensburg conducted a prospective randomized and controlled trial on patients who had undergone major non-cardiac surgery were screened with the biomarker test immediately after admission to the intensive care unit (ICU). The urinary biomarker-triggered KDIGO care and was compared to standard ICU care in 121 patients with an increased AKI risk after major abdominal surgery that was determined by urinary biomarker. The biomarkers was inhibitor of metalloproteinase-2 × insulin-like growth factor-binding protein 7, equaled greater than 0.3. Incidence of overall AKI, severity of AKI, length of stay, major kidney events at discharge, and cost effectiveness were evaluated.
The team used the NephroCheck test, which is intended for use in conjunction with clinical evaluation of ICU patients who currently have or have had acute cardiovascular or respiratory compromise within the past 24 hours, as an aid in assessing the patient’s risk for moderate or severe AKI within the following 12 hours. Patients found to be NephroCheck test positive for the risk of AKI (AKI risk score greater than 0.3) were then randomized to standard care (61 patients) or intervention (60 patients). The NephroCheck test system is intended to be used in patients 21 years of age or older.
The study’s primary endpoint was the incidence of AKI during the first seven days after surgery. In the intervention group, 19 patients (31.7%) developed some level of AKI; in the control group, 29 patients (47.5%) developed some level of AKI. Biomarker-guided therapy significantly reduced the incidence of moderate and severe AKI in the intervention group to 6.7% compared to 19.7% in the standard care group, a 66% reduction.
Ivan Göcze, MD, the lead author of the study, said, ““It appears the prediction of imminent AKI at the very early stage, followed by optimal fluid resuscitation with less positive fluid balance and kidney protection, led to the improved outcomes, meaning the reduced incidence and severity of AKI, as well as a decrease in postoperative creatinine levels and length of hospital stay,” The study was originally published on August 29, 2017, in the journal Annals of Surgery.
University Hospital Regensburg