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Can biomarkers be utilized to guide the therapy of AKI?

Several candidate biomarkers have been proposed for the early diagnosis of forms of AKI. Are these biomarkers sufficiently sensitive and specific to guide therapeutic interventions? Do they provide robust prognositc information

Comment

Submitted by Paul Palevsky 3 years ago

Comments (7)

  1. Moderator

    There are little data to guide use of biomarkers to gauge response to therapy -- a key characteristic of biomarkers -- since we have few therapeutics to provide -- except fluid administration / hemodynamic stabilization in patients with pre-renal azotemia

    3 years ago
  2. Paul Palevsky Idea Submitter

    I would agree that we have little data at this point. What are the criteria for biomarkers that would need to be fulfilled in order to be useful in either the research or clinical arenas. Validation of biomarkers may need to go hand-in-hand with testing of potential therapeutic agents

    3 years ago
  3. I think ideally biomarkers should be able to do the following to be useful:

    1. Identify early in the course, the presence of injury to the kidney and be specific and sensitive.

    2. Reliably identify early in the course, the severity of renal dysfunction.

    3. Be able to mark the progression of AKI into different stages.

    4. And finally, be able to identify renal recovery.

    3 years ago
  4. Moderator

    Thanks -- good points -- we should add predict response to therapy as well

    3 years ago
  5. These are good points. I think we need do more research on sublethal/subclinical injury and how kidney recovery from it without any problem. If we have knowledge on this, we can enhance recovery process and also we may able to suppress injury.

    3 years ago
  6. It is also very important that the biomarker could help to identify etiology. It is very challenging to treat an AKI with multiple pathogenic mechanisms. Sometimes the only therapy is to interrupt a nephrotoxic agent(and I am not talking about an well known agent). Especially when you have also another mechanism that trigger AKI, i.e an acute coronary syndrome. So,you have to do a panel of biomarkers for each patient in order to identify the correct injury in order to help us to guide the exact therapy, in an individualized manner.

    3 years ago
  7. Treatment of patient with AKI is different from patients without AKI. So, although no specific pharmacologic intervention for patients with AKI is available, data and logic suggest that appropriate care of patients with AKI will improve outcomes. Thus a trial combining biomarkers for early diagnosis and then "excellent supprotive care" with the following interventions 1) avoidance of nephrotoxins (including IV contrast), 2) conservative fluid strategy, 3) appropriate medication dosing, and/or 4) low tidal volume mechanical ventilation would likely be a strategy that would validate biomarkers and develop a best practice strategy in AKI. (I suggest low tidal volume ventilation as a strategy as it is well known that mortality drastically increases in the setting of AKI and mechanical ventilation and low tidal ventilation may be a way to affect improve outcomes in this setting). This is where we should start and could be the start of a clinical trials network which needs to be developed and then maintained.

    3 years ago

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