- Poster presentation
- Open Access
Acute kidney injury biomarkers offer the opportunity to reduce exposure to nephrotoxic drugs
Critical Care volume 19, Article number: P295 (2015)
Tissue inhibitor of metalloproteinase-2 (TIMP-2) and insulin-like growth factor binding protein 7 (IGFBP7) are specific urinary biomarkers which can predict acute kidney injury (AKI) in critically ill patients within 12 hours . A [TIMP-2]·[IGFBP7] result >0.3 (ng/ml)2/1,000 is associated with seven times the risk of AKI compared with a test result ≤0.3 . The aim of our study was to explore the use of potentially nephrotoxic medications within the window between a positive biomarker test and the diagnosis of AKI stage 2 or 3.
We identified all patients enrolled into the Sapphire study  who received at least one potentially nephrotoxic drug on the day of AKI (defined by stage 2 or 3 as per KDIGO classification). We subsequently determined the proportion of patients who had a [TIMP-2]·[IGFBP7] result >0.3 (ng/ml)2/1,000 before meeting the criteria for AKI.
Of 184 patients who developed AKI, 58% received one or more potentially nephrotoxic drug on the day of AKI. Eighty-nine percent of these patients had a positive biomarker test ≥12 hours earlier. In 41% of patients receiving one or more nephrotoxic drug on the day of AKI, at least one nephrotoxic medication was stopped within 1 day of AKI, and in 24% of patients all nephrotoxic drugs were stopped within 1 day of AKI, which implies that these medications were not absolutely necessary.
Nephrotoxic medications are commonly used in patients who develop moderate or severe AKI. The [TIMP-2]·[IGFBP7] test could have identified many of these patients earlier and would have offered an opportunity to reduce exposure to non-essential nephrotoxic drugs.
Kashani K, et al: Discovery and validation of cell cycle arrest biomarkers in human acute kidney injury. Crit Care. 2013, 17: R25-10.1186/cc12503.
Bihorac A, et al: Validation of cell-cycle arrest biomarkers for acute kidney injury: using clinical adjudication. Am J Resp Crit Care Med. 2014, 932-9. 189
About this article
Cite this article
Ostermann, M., Forni, L., Kashani, K. et al. Acute kidney injury biomarkers offer the opportunity to reduce exposure to nephrotoxic drugs. Crit Care 19, P295 (2015). https://doi.org/10.1186/cc14375
- Growth Factor
- Emergency Medicine
- Factor Binding
- Acute Kidney Injury