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

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.