Use of tissue inhibitor of metalloproteinase 2 and insulin -like growth factor binding protein 7 [TIMP2]•[IGFBP7] as an AKI risk screening tool to manage patients in the real-world setting

Purpose: To determine the application of various components of the Kidney Disease Improving Global Outcomes (KDIGO) bundle inmanaging patients at high-risk for AKI progression ([TIMP2][IGFBP7] N0.3) in the real-world setting. Methods: Patients with a [TIMP2][IGFBP7] test ordered between 5/23/16-2/28/18were evaluated. We reviewed the medical record for evidence of implementation of the KDIGO bundle in response to biomarker test results. Evidence including explicit documentation in physicians' note discussing [TIMP2][IGFBP7] results and implicit evidence from review of dose adjusted medications, discontinued nephrotoxins and therapeutic drug monitoring. Results: 105 [TIMP2][IGFBP7] tests were conducted in 100 patients (54% female; mean age 55.4 +/- 16.8; 89% in the ICU). Sixty-one patients had a value of N0.3 and 46 (75.4%) of these patients received at least one management strategy consistent with KDIGO. By contrast, nine patients (23.1%) with [TIMP2][IGFBP7] =0.3 received one or more components of the KDIGO bundle (p b.001). Conclusion: In a real-world setting the use of urinary [TIMP2][IGFBP7] as an AKI risk screening tool resulted in differential application of various components of the KDIGO bundle for patientmanagement for thosewith a positive test result. (c) 2020 Elsevier Inc. All rights reserved.