Improving detection of acute kidney injury in patients seen in the emergency department
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Citation
Abstract
Acute kidney injury (AKI) is a common cause of morbidity and mortality across the world and reduction of these complications is highly dependent on how quickly patients receive corrective treatment for the AKI. The initial presentation of patients is often at the emergency department (ED), which is the first opportunity for these interventions to take place. The current KDIGO guidelines for diagnosis of AKI involve serum creatinine (sCr) and urine output, parameters that carry a number of flaws. Three biomarkers have been proposed in the literature as being alternatives to the use of serum creatinine in the standardized diagnosis of AKI: urine neutrophil gelatinase-associated lipocalin (uNGAL), urine kidney injury molecule-1 (uKIM-1), and serum cystatin C (sCysC).
These biomarkers show comparable AUCs to sCr in studies that have been performed on the heterogeneous population of patient’s presenting to the ED, although the body of work is limited. The study proposed in this paper is a prospective cohort study to identify the biomarker that is most rapidly able to identify AKI. The study will enroll patients presenting to the ED at several major hospitals throughout Massachusetts over the course of 4 months. These patients will have series measurements taken of sCr, uNGAL, uKIM-1, and sCysC over 48 hours. Statistical analysis will be performed to evaluate the difference in AUC between sCr and each of its proposed alternatives in order to determine those that are best at identifying AKI and the time point at which AKI can be detected will be monitored. It is expected that this study will support the use of one biomarker over the others using data from a large sample population and a diverse set of patients.
There is need for a test that provides earlier and more reliable detection of AKI than sCr in heterogeneous populations and this study aims to support a potential alternative biomarker for this purpose. If used clinically, the research provided by this study is hoped to allow for earlier intervention to prevent worsening of AKI and thus avoid the increased morbidity and mortality associated with severe AKI for hospitalized patients across the United States.