Personalizing AKI Management: A Clinical Outlook

Acute kidney injury (AKI) is a complex condition that is increasingly common among people with acute illnesses, including COVID-19. While there are differing perspectives within the medical community on various aspects of AKI management, most agree that we all still have more to learn as we seek to optimize care and improve outcomes for these critically ill patients. As we continue to conduct research and generate data to advance our collective knowledge base, it's imperative that we recognize and embrace the necessity of taking a tailored approach to care that prioritizes individual needs.

For instance, there has been a longstanding research question around the ideal timing for initiating renal replacement therapy (RRT), which replaces the function of the kidneys and is the cornerstone of treatment for people with severe AKI.¹ This is a significant topic that warrants further study to better understand and address. However, before deciding when to initiate RRT, it’s critical to consider whether the patient will benefit from RRT in the first place – are they likely to recover on their own or will they require more intensive management? In my view, a key component to answering this question involves assessing the patient’s risk of developing a more severe and persistent form of AKI that is associated with poor outcomes and requires different treatment modalities.  

Currently, clinicians are evaluating the likelihood of renal recovery and making decisions about RRT with conventional markers such as serum creatinine and urine output, which have well-known limitations. Identifying AKI patients at risk for persistent severe AKI could provide clinicians with information to help guide evaluation and management strategies, as well as anticipate the need for appropriate interventions, such as RRT. Driving purposeful innovation in the assessment of persistent severe AKI, including identification of new biomarkers, will play a major role in supporting personalized care and improve outcomes by identifying who is likely to benefit from RRT.

I'm encouraged by a recent study supporting the CCL14 biomarker, which is being developed by bioMérieux for use in assessing the risk of a patient with moderate or severe AKI developing persistent severe AKI. Baxter recently entered into an exclusive agreement with bioMérieux to distribute the CCL14 biomarker in Europe and the U.S. following regulatory approval and launch in both markets. We are committed to advancing research and delivering solutions for personalized AKI management to help support the decision making of intensivists and nephrologists in planning treatments for their patients with persistent severe AKI.