title: Using biomarkers for acute kidney injury: barriers and solutions.
abstract: The clinical implementation of urinary and plasma renal injury biomarkers has been hampered by the variability associated with nonstandardized commercially available biomarker assays, uncertainty and variations in patient selection criteria, and the absence of context-specific cutoffs for biomarker concentrations. These limitations are increased by comparison with serum creatinine to define acute kidney injury. The critical problem affecting biomarker performance is patient heterogeneity involving the cause, context (including comorbidity and baseline renal function), and timing of the injury. We suggest strategies for stratifying subjects to provide appropriate context, and illustrate a creatinine-independent method for defining thresholds for biomarker concentrations in these contexts which utilizes the same sensitivity for the clinical outcomes of dialysis or death. Large multicenter cohort studies are needed to validate the proposed cutoffs.
authors.affiliation: Department of Nephrology, Prince of Wales Hospital, and Prince of Wales Clinical School, University of New South Wales, Sydney, N.S.W., Australia.
authors.forename: Zoltán H
authors.initials: ZH
authors.lastname: Endre
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000145:classification / Q000175:diagnosis* / Q000401:mortality / Q000652:urine; D000209:Acute-Phase Proteins / Q000652:urine; D000328:Adult; D019540:Area Under Curve; D015415:Biomarkers / Q000032:analysis* / Q000097:blood / Q000652:urine; D002648:Child; D001026:Coronary Artery Bypass; D003404:Creatinine / Q000097:blood; D042241:Early Diagnosis; D050556:Fatty Acid-Binding Proteins / Q000652:urine; D005919:Glomerular Filtration Rate; D000072596:Hepatitis A Virus Cellular Receptor 1; D006801:Humans; D020382:Interleukin-18 / Q000652:urine; D007677:Kidney Function Tests / Q000592:standards; D000071068:Lipocalin-2; D054834:Lipocalins / Q000097:blood / Q000652:urine; D008562:Membrane Glycoproteins / Q000652:urine; D015337:Multicenter Studies as Topic; D009994:Osmolar Concentration; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis / Q000652:urine; D016016:Proportional Hazards Models; D011518:Proto-Oncogene Proteins / Q000097:blood / Q000652:urine; D011991:Receptors, Virus; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; C493319:FABP1 protein, human; D050556:Fatty Acid-Binding Proteins; C491143:HAVCR1 protein, human; D000072596:Hepatitis A Virus Cellular Receptor 1; C000589760:IL18 protein, human; D020382:Interleukin-18; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D008562:Membrane Glycoproteins; D011518:Proto-Oncogene Proteins; D011991:Receptors, Virus; D003404:Creatinine