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

Hospital acquired acute kidney injury (AKI) is one of the most common organ dysfunctions in elderly and critically ill patients and adversely impacts on short-term as well as on long-term clinical outcomes. Early diagnosis of AKI, preferably within 12 to 24 hours after onset of the renal insult, is pivotal to the development of effective therapies attenuating acute kidney dysfunction severity or fastening renal recovery. Traditional biomarkers like creatinine are late indicators of AKI. The cell cycle arrest biomarkers (CCABs) tissue inhibitor of metalloproteinase-2 and insulin like growth factor binding protein-7 accurately predicted moderate to severe 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.