Evidence map›Paper›PMID 29541790›Full record

SynthesisIntensive care medicine2018

Biomarkers for prediction of renal replacement therapy in acute kidney injury: a systematic review and meta-analysis.

Sebastian J Klein, Anna K Brandtner, Georg F Lehner, Hanno Ulmer, Sean M Bagshaw, Christian J Wiedermann, Michael Joannidis

Abstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Intensive care medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 95 papers, 8 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
95citing papers in PubMed, 8 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

95 citing papers in PubMed, 8 syntheses or guidelines pooled it.

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35 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

7 authors.

Sebastian J KleinDivision of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
Anna K BrandtnerDivision of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
Georg F LehnerDivision of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
Hanno UlmerDepartment of Medical Statistics, Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria.
Sean M BagshawDepartment of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
Christian J WiedermannUMIT-The Health and Life Sciences University, Hall, Austria.
Michael JoannidisDivision of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria. michael.joannidis@i-med.ac.at.ORCID 0000-0002-6996-0881

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeAcute kidney injury (AKI) frequently occurs in critically ill patients and often precipitates use of renal replacement therapy (RRT). However, the ideal circumstances for whether and when to start RRT remain unclear. We performed evidence synthesis of the available literature to evaluate the value of biomarkers to predict receipt of RRT for AKI.

methodsWe conducted a PRISMA-guided systematic review and meta-analysis including all trials evaluating biomarker performance for prediction of RRT in AKI. A systematic search was applied in MEDLINE, Embase, and CENTRAL databases from inception to September 2017. All studies reporting an area under the curve (AUC) for a biomarker to predict initiation of RRT were included.

resultsSixty-three studies comprising 15,928 critically ill patients (median per study 122.5 [31-1439]) met eligibility. Forty-one studies evaluating 13 different biomarkers were included. Of these biomarkers, neutrophil gelatinase-associated lipocalin (NGAL) had the largest body of evidence. The pooled AUCs for urine and blood NGAL were 0.720 (95% CI 0.638-0.803) and 0.755 (0.706-0.803), respectively. Blood creatinine and cystatin C had pooled AUCs of 0.764 (0.732-0.796) and 0.768 (0.729-0.807), respectively. For urine biomarkers, interleukin-18, cystatin C, and the product of tissue inhibitor of metalloproteinase-2 and insulin growth factor binding protein-7 showed pooled AUCs of 0.668 (0.606-0.729), 0.722 (0.575-0.868), and 0.857 (0.789-0.925), respectively.

conclusionThough several biomarkers showed promise and reasonable prediction of RRT use for critically ill patients with AKI, the strength of evidence currently precludes their routine use to guide decision-making on when to initiate RRT.

Indexed as

Acute Kidney InjuryBiomarkersRenal Replacement TherapyAcute-Phase ProteinsHumansLipocalin-2LipocalinsProspective StudiesProto-Oncogene ProteinsTissue Inhibitor of Metalloproteinase-2Acute-Phase ProteinsBiomarkersLipocalin-2LipocalinsProto-Oncogene ProteinsTissue Inhibitor of Metalloproteinase-2Acute kidney injuryBiomarkersMeta-analysisPredictionRenal replacement therapy

Identifiers

PMID29541790
PMCPMC5861176

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.