Cell cycle arrest biomarkers for the early prediction of acute kidney injury - full of promise, but not a must–have for yet

Implication for health policy/practice/research/medical education: The cell cycle arrest biomarkers (CCABs) tissue inhibitor of metalloproteinase2 and insulin like growth factor binding protein -7 accurately predicted moderate to severe acute kidney injury (AKI) in high-risk cardiothoracic surgery patients within 12 hours. These CCABs outperformed the most promising current biomarkers. The NephroCheck test system represents a promising tool inching closer to widespread clinical application and received FDA approval in September 2014. However, there is an urgent need to demonstrate the cost-effectiveness of this biomarker test system whether alone or in combination with biomarkers of other pathways. Most importantly, further trials should validate the cut-off values in patient populations other than intensive care unit (ICU) and cardiac surgery. Please cite this paper as: Schiffl H. Cell cycle arrest biomarkers for the early prediction of acute kidney injury full of promise, but not a must–have for yet. J Renal Inj Prev. 2017;6(3):177-183. DOI: 10.15171/jrip.2017.34. R ev ie w Introduction Conceptually, acute kidney injury (AKI) is defined as an abrupt (over hours to days) decrease in glomerular filtration rate (GFR), resulting in retention of creatinine, urea and other waste products and in dysregulation of body fluid, electrolyte and acid-base homeostasis. Clinically, this disorder has multiple etiologies and risk factors, encompasses a broad spectrum of manifestations ranging from tubular stress to oligo-anuric renal failure and is associated with unpredictable outcomes. AKI is a common problem amongst hospitalized patients, especially in elderly patients whose numbers are increasing and in those treated in the intensive care unit (1). This renal disorder is no longer considered an innocent bystander merely reflecting the severity of precipitating acute illness or of coexisting pathologies. Irrespective of its nature, severity and duration AKI is an independent and strong determinant of in hospital mortality, intensive care unit (ICU) readmission and post-discharge renal and cardiovascular morbidity and mortality. At present, prevention of AKI focuses on the optimization of cardiac filling pressure to improve renal perfusion and on the avoidance of exposure to nephrotoxins. Management of established AKI is primarily supportive. In spite of