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AACC Releases New Guidelines for Diagnosing, Managing Acute Kidney Injury

NEW YORK – The American Association for Clinical Chemistry on Tuesday released new guidelines for labs and healthcare professionals on managing acute kidney injury.

The organization said that the guidelines aim to improve and make more consistent approaches to AKI care, which it noted currently vary widely, leading to considerable disparities around the world in identifying and managing the condition.

AKI is defined as a sudden episode of kidney damage or failure and can lead to serious complications or death. It can be triggered by a range of causes including surgeries and medications and is estimated to affect up to 15 percent of hospitalized patients.

One of the major issues the new guidance addresses are problems around the use of creatinine testing to diagnose AKI. Current diagnostic thresholds for creatinine testing, which were set by the 2012 Kidney Disease Improving Global Outcomes, or KDIGO, guidelines, have been shown to return a high number of false positive AKI diagnoses. The guidelines released this week recommend a new diagnostic threshold that was identified via a study of 14,912 adult patients.

The guidance document also covers other best practices for creatinine testing including setting standards for assay performance, as well as guidance on the use of other tests, including recently developed markers and machine learning tools, for identifying and managing AKI.

It recommended against regular use of certain markers including the TIMP2 and IGFBP7 protein markers that comprise BioMérieux's Nephrocheck test for AKI, noting that the test "is not yet recommended for routine risk assessment of AKI due to the lack of evidence of benefit shown in outcome studies, high false positive rate, and limited performance studies outside of the intensive care unit or perioperative setting."

"Our understanding of and tools used for detecting AKI have both evolved since KDIGO was published in 2012," the guidance’s lead authors, Joe El-Khoury, associate professor of laboratory medicine at Yale School of Medicine, and Chirag Parikh, director of the division of nephrology and professor of medicine at Johns Hopkins Medicine, said in a statement. "The information and opinions provided within this document are intended to shed light on the current status of the field and generate a healthy debate with clinical organizations that leads to a much-needed update to our current practice of investigating AKI."