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Subclinical AKI: ready for primetime in clinical practice?

Raymond Vanholder (UGent) , Norbert Lameire (UGent) , Jill Vanmassenhove (UGent) and Wim Van Biesen (UGent)
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Abstract
There has been considerable progress over the last decade in the standardization of the acute kidney injury (AKI) definition with the publication of the RIFLE, AKIN, KDIGO and ERBP classification criteria. However, these classification criteria still rely on imperfect parameters such as serum creatinine and urinary output. The use of timed urine collections, kinetic eGFR (estimated glomerular filtration rate), real time measurement of GFR and direct measures of tubular damage can theoretically aid in a more timely diagnosis of AKI and improve patients' outcome. There has been an extensive search for new biomarkers indicative of structural tubular damage but it remains controversial whether these new markers should be included in the current classification criteria. The use of these markers has also led to the creation of a new concept called subclinical AKI, a condition where there is an increase in biomarkers but without clinical AKI, defined as an increase in serum creatinine and/or a decrease in urinary output. In this review we provide a framework on how to critical appraise biomarker research and on how to position the concept of subclinical AKI. The evaluation of biomarker performance and the usefulness of the concept 'subclinical AKI' requires careful consideration of the context these biomarkers are used in (clinical versus research setting) and the goal we want to achieve (risk assessment versus prediction versus early diagnosis versus prognostication). It remains currently unknown whether an increase in biomarkers levels without functional repercussion is clinically relevant and whether including biomarkers in classification criteria will improve patients' outcome.
Keywords
AKI, Biomarkers, Real time GFR, Renal functional reserve, Serum creatinine kinetics, Subclinical AKI

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Please use this url to cite or link to this publication:

Chicago
Vanholder, Raymond, Norbert Lameire, Jill Vanmassenhove, and Wim Van Biesen. 2018. “Subclinical AKI: Ready for Primetime in Clinical Practice? .” Journal of Nephrology Dec 6.
APA
Vanholder, R., Lameire, N., Vanmassenhove, J., & Van Biesen, W. (2018). Subclinical AKI: ready for primetime in clinical practice? . Journal of Nephrology, Dec 6.
Vancouver
1.
Vanholder R, Lameire N, Vanmassenhove J, Van Biesen W. Subclinical AKI: ready for primetime in clinical practice? . Journal of Nephrology. 2018;Dec 6.
MLA
Vanholder, Raymond et al. “Subclinical AKI: Ready for Primetime in Clinical Practice? .” Journal of Nephrology Dec 6 (2018): n. pag. Print.
@article{8587123,
  abstract     = {There has been considerable progress over the last decade in the standardization of the acute kidney injury (AKI) definition with the publication of the RIFLE, AKIN, KDIGO and ERBP classification criteria. However, these classification criteria still rely on imperfect parameters such as serum creatinine and urinary output. The use of timed urine collections, kinetic eGFR (estimated glomerular filtration rate), real time measurement of GFR and direct measures of tubular damage can theoretically aid in a more timely diagnosis of AKI and improve patients' outcome. There has been an extensive search for new biomarkers indicative of structural tubular damage but it remains controversial whether these new markers should be included in the current classification criteria. The use of these markers has also led to the creation of a new concept called subclinical AKI, a condition where there is an increase in biomarkers but without clinical AKI, defined as an increase in serum creatinine and/or a decrease in urinary output. In this review we provide a framework on how to critical appraise biomarker research and on how to position the concept of subclinical AKI. The evaluation of biomarker performance and the usefulness of the concept 'subclinical AKI' requires careful consideration of the context these biomarkers are used in (clinical versus research setting) and the goal we want to achieve (risk assessment versus prediction versus early diagnosis versus prognostication). It remains currently unknown whether an increase in biomarkers levels without functional repercussion is clinically relevant and whether including biomarkers in classification criteria will improve patients' outcome.},
  author       = {Vanholder, Raymond and Lameire, Norbert and Vanmassenhove, Jill and Van Biesen, Wim},
  journal      = {Journal of Nephrology},
  title        = {Subclinical AKI: ready for primetime in clinical practice? },
  url          = {http://dx.doi.org/10.1007/s40620-018-00566-y},
  volume       = {Dec 6},
  year         = {2018},
}

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