Clinical Focus
Getting ahead of AKI benefits patients and clinical teams.
AKI has many causes, affecting patients and providers across multiple specialties.
Critical Care
AKI occurs in 1 in 4 critically ill pediatric patientsi and severe AKI is independently associated with an increased need for dialysis, mechanical ventilation and longer stays in the ICU.i “Using serum creatinine alone “failed to identify 2/3 of pediatric patients with AKI.”i
Risk-stratifying patients in danger of AKI gives intensivists the chance to get ahead of kidney damage and initiate measures to tailor management.
“Our data demonstrates that prediction of AKI severity on Day 3 [following PICU admission] can be made more precise via the integration of an AKI biomarker with SCr.…This is supported by existing evidence suggesting that early recognition of post-surgical patients at high risk for AKI followed by the implementation of standardized KDIGO management bundles can decrease AKI disease burden.”
— Stanski N, et al., Journal of Critical Care 2019
Cardiac Surgery
AKI complicates recovery from cardiac surgery in up to 30% of patients, placing them at a 5x increased risk of death during hospitalization.ii
Characteristics of cardiac surgery that increase risk of kidney injury include:
- Cardiopulmonary bypass (CPB)
- High rates/volumes of exogenous blood product transfusion
- High doses of exogenous vasopressors
These interventions change renal perfusion, induce cycles of ischemia and reperfusion, increase oxidative damage, and increase inflammation, which can induce the development of AKI.ii
“NGAL is detected within 2-6 hours of CPB in children destined for AKI, with a predictive area under the receiver operating characteristic curve (AUC) of >0.9. These findings have now been confirmed in >7,500 patients, with measurements obtained within 4-6 hours of CPB, yielding an overall predictive pooled AUC of 0.86.”
— Ciccia E, Devarajan P, International Journal of Nephrology and Renovascular Disease, 2017.
Transplant
Acute kidney injury (AKI) affects roughly 25% of all recipients of deceased donor organs and is associated with shortened graft survival as well as with longer ICU stays, need for postoperative dialysis, infectious complications, acute rejection, and reduced patient survival.iii
Using novel biomarkers to assess AKI risk in pediatric transplant recipients can provide information beyond serum creatinine, when considering management decisions about fluid balance and/or the use of nephrotoxic drugs.
“Adding NGAL measurements significantly improved the risk prediction of the current clinical model for the diagnosis of DGF.”
— Haase-Fielitz A, et al., Ann Clin Biochem. 2014
Laboratory
Laboratory medicine for critically ill patients centers around delivering timely and accurate results when they offer maximal clinical value, and ideally when they anticipate changes in a patient’s health status.
Because NGAL levels rise within 2 hours of injury, and can precede creatinine changes by two to three days, ProNephro AKI (NGAL)* can help the lab warn the ICU when a patient’s risk of AKI is changing.
Identifying AKI faster has been shown to reduce time on ventilation and dialysis, as well as shorten length of stay (LOS).iv
*ProNephro AKI (NGAL) is FDA-cleared for use in the United States.
“A modest literature search indicates that [with AKI] there’s a substantial increase in-hospital mortality, increased transition to chronic kidney disease is substantial, and a substantial increase in hospitalization costs. So, if you scale this up, it is on the radar screen for health care costs in the United States.”
— James Crawford, MD, PhD, Senior Vice President, Laboratory Services Northwell Health, CAP Today, July 2016
Healthcare System
The cost of hospital-acquired AKI has been conservatively estimated to be at least $10 Billion annually.v This staggering cost is in part due to the challenging reality that AKI is recognized late, when mitigating kidney damage requires more intensive, costly and challenging intervention.
A study examining 6,729 children across 49 US hospitals found that AKI added $5,367 per episode.vi Another study found that in the year following discharge, children with AKI requiring dialysis had 3x greater healthcare costs and utilization, including rehospitalization, and ED/outpatient visits.vii