Biomarkers for prediction of renal replacement therapy in acute kidney injury: a systematic review and meta-analysis.

Abstract:

PURPOSE:Acute kidney injury (AKI) frequently occurs in critically ill patients and often precipitates use of renal replacement therapy (RRT). However, the ideal circumstances for whether and when to start RRT remain unclear. We performed evidence synthesis of the available literature to evaluate the value of biomarkers to predict receipt of RRT for AKI. METHODS:We conducted a PRISMA-guided systematic review and meta-analysis including all trials evaluating biomarker performance for prediction of RRT in AKI. A systematic search was applied in MEDLINE, Embase, and CENTRAL databases from inception to September 2017. All studies reporting an area under the curve (AUC) for a biomarker to predict initiation of RRT were included. RESULTS:Sixty-three studies comprising 15,928 critically ill patients (median per study 122.5 [31-1439]) met eligibility. Forty-one studies evaluating 13 different biomarkers were included. Of these biomarkers, neutrophil gelatinase-associated lipocalin (NGAL) had the largest body of evidence. The pooled AUCs for urine and blood NGAL were 0.720 (95% CI 0.638-0.803) and 0.755 (0.706-0.803), respectively. Blood creatinine and cystatin C had pooled AUCs of 0.764 (0.732-0.796) and 0.768 (0.729-0.807), respectively. For urine biomarkers, interleukin-18, cystatin C, and the product of tissue inhibitor of metalloproteinase-2 and insulin growth factor binding protein-7 showed pooled AUCs of 0.668 (0.606-0.729), 0.722 (0.575-0.868), and 0.857 (0.789-0.925), respectively. CONCLUSION:Though several biomarkers showed promise and reasonable prediction of RRT use for critically ill patients with AKI, the strength of evidence currently precludes their routine use to guide decision-making on when to initiate RRT.

journal_name

Intensive Care Med

journal_title

Intensive care medicine

authors

Klein SJ,Brandtner AK,Lehner GF,Ulmer H,Bagshaw SM,Wiedermann CJ,Joannidis M

doi

10.1007/s00134-018-5126-8

subject

Has Abstract

pub_date

2018-03-01 00:00:00

pages

323-336

issue

3

eissn

0342-4642

issn

1432-1238

pii

10.1007/s00134-018-5126-8

journal_volume

44

pub_type

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