Ronco Claudio, Rizo-Topete Lilia, Serrano-Soto Mara, Kashani Kianoush
International Renal Research Institute (IRRIV), San Bortolo Hospital, Vicenza, Italy.
Department of Nephrology Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy.
Nephrol Dial Transplant. 2017 Mar 1;32(3):408-413. doi: 10.1093/ndt/gfx016.
Acute kidney injury (AKI) is a common condition in critically ill patients. Multiple studies have identified AKI as a strong independent risk factor for higher morbidity and mortality. AKI is often multifactorial, asymptomatic and difficult to predict. In recent years, the discovery of several AKI biomarkers, including the recent validation and approval of cell cycle arrest biomarkers (NephroCheck, Astute Medical, San Diego, CA, USA), has provided additional tools to detect patients at high risk of AKI and improve their outcomes. We propose a protocol to integrate the use of NephroCheck into a multidisciplinary rapid clinical response team to potentially reduce AKI development, severity and the number of patients who need dialysis. We have designed a stepped alarm system for nephrologists and critical care physicians that starts with the recognition of high-risk patients in the clinical setting. The evaluation of patients' clinical situation together with the NephroCheck value will lead to a list of recommendations to prevent the development of AKI or progression to acute kidney stress or injury. We propose that the routine clinical application of a NephroCheck Rapid Response Team (RRT), where the NephroCheck RRT acts under the principle of improving safety and avoiding deterioration of patients, can impact patients' well-being in a positive way.
急性肾损伤（AKI）是危重症患者的常见病症。多项研究已将AKI确定为发病率和死亡率升高的强大独立危险因素。AKI通常是多因素的，无症状且难以预测。近年来，几种AKI生物标志物的发现，包括最近细胞周期停滞生物标志物（NephroCheck，美国加利福尼亚州圣地亚哥市Astute Medical公司）的验证和批准，为检测AKI高危患者并改善其预后提供了更多工具。我们提出了一项方案，将NephroCheck的使用纳入多学科快速临床反应团队，以潜在地减少AKI的发生、严重程度以及需要透析的患者数量。我们为肾病科医生和重症监护医生设计了一个分级警报系统，该系统从在临床环境中识别高危患者开始。对患者临床情况与NephroCheck值的评估将产生一系列建议，以防止AKI的发生或进展为急性肾应激或损伤。我们建议NephroCheck快速反应团队（RRT）的常规临床应用，其中NephroCheck RRT按照提高安全性和避免患者病情恶化的原则行事，可以以积极的方式影响患者的健康状况。
