Trial reportCritical care (London, England)2022
Proenkephalin A 119-159 predicts early and successful liberation from renal replacement therapy in critically ill patients with acute kidney injury: a post hoc analysis of the ELAIN trial.
Trial report in Critical care (London, England), 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 2 of them syntheses that pooled it.
What it found
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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.
Who cites it
20 citing papers in PubMed, 2 syntheses or guidelines pooled it, 33 citations in OpenAlex.
- Novel biomarkers for predicting successful liberation of renal replacement therapy for acute kidney injury: a systematic review.Critical care (London, England) · 2025Pooled it
- The efficacy of novel biomarkers for the early detection and management of acute kidney injury: A systematic review.PloS one · 2025Pooled it
- Association of urinary post-translationally modified fetuin-a and outcomes in acute kidney disease.BMC nephrology · 2026Article
- Biomarker-Based Diagnosis and Risk Stratification in Sepsis-Associated Acute Kidney Injury: From Molecular Mechanisms to Multimarker Panels.Diagnostics (Basel, Switzerland) · 2026Review
- Renal replacement therapy in intensive care unit: a narrative review.Annals of intensive care · 2026Review
- Proenkephalin A for assessing kidney integrity and guiding KRT liberation decisions in critically ill patients.Annals of intensive care · 2026Article
- What new renal biomarkers tell us about renal physiology: Collection: physiology applied to ICU.Annals of intensive care · 2026Review
- Evaluation of a Novel Biomarker Panel for Acute Kidney Injury Following Endovascular Aortic Repair.International journal of molecular sciences · 2025Article
- Proenkephalin A 119-159 as an early biomarker of acute kidney injury in complex endovascular aortic repair: an explorative single-center cross-sectional study with the utilization of two measurement methods.Perioperative medicine (London, England) · 2025Article
- Biomarkers in acute kidney injury settings to predict interventions and outcomes: the MARKISIO study.Critical care (London, England) · 2025Article
- Current role of biomarkers in the initiation and weaning of kidney replacement therapy in acute kidney injury.World journal of nephrology · 2025Review
- Implementation and One-Year Evaluation of Proenkephalin A in Critical Care.International journal of molecular sciences · 2025Article
- Can Novel Biomarkers Effectively Predict Acute Kidney Injury in Liver or Kidney Transplant Recipients?International journal of molecular sciences · 2024Review
- Proenkephalin A 119-159 in Perioperative and Intensive Care-A Promising Biomarker or Merely Another Option?Diagnostics (Basel, Switzerland) · 2024Review
- Unveiling the enigma of acute kidney disease: predicting prognosis, exploring interventions, and embracing a multidisciplinary approach.Kidney research and clinical practice · 2024Article
- Predictive approach for liberation from acute dialysis in ICU patients using interpretable machine learning.Scientific reports · 2024Article
- From Acute to Chronic: Unraveling the Pathophysiological Mechanisms of the Progression from Acute Kidney Injury to Acute Kidney Disease to Chronic Kidney Disease.International journal of molecular sciences · 2024Review
- Questionable Validity of Creatinine-Based eGFR in Elderly Patients but Cystatin C Is Helpful in First-Line Diagnostics.Geriatrics (Basel, Switzerland) · 2023Article
- NephroCheck at 10: addressing unmet needs in AKI diagnosis and risk stratification.Clinical kidney journal · 2023Article
- Biomarkers as Prognostic Predictors and Therapeutic Guide in Critically Ill Patients: Clinical Evidence.Journal of personalized medicine · 2023Review
Corrections and comments
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Authors and funding
9 authors at 3 institutions in 2 countries.
Funding
Abstract
backgroundRenal replacement therapy (RRT) remains the key rescue therapy for critically ill patients with severe acute kidney injury (AKI). However, there are currently no tools available to predict successful liberation from RRT. Biomarkers may allow for risk stratification and individualization of treatment strategies. Proenkephalin A 119-159 (penKid) has been suggested as a promising marker of kidney function in the context of AKI, but has not yet been evaluated for RRT liberation in critically ill patients with AKI.
methodsThis post hoc analysis included 210 patients from the randomized clinical ELAIN trial and penKid levels were measured in the blood of these patients. Competing risk time-to-event analyses were performed for pre-RRT penKid at initiation of RRT and in a landmark analysis at day 3 after initiation of RRT. Competing risk endpoints were successful liberation from RRT or death without prior liberation from RRT.
resultsLow pre-RRT penKid levels (penKid ≤ 89 pmol/l) at RRT initiation were associated with early and successful liberation from RRT compared to patients with high pre-RRT penKid levels (subdistribution hazard ratio (sHR) 1.83, 95%CI 1.26-2.67, p = 0.002, estimated 28d-cumulative incidence function (28d-CIF) of successful liberation from RRT 61% vs. 45%, p = 0.022). This association persisted in the landmark analysis on day 3 of RRT (sHR 1.78, 95%CI 1.17-2.71, p = 0.007, 28d-CIF of successful liberation from RRT 67% vs. 47%, p = 0.018). For both time points, no difference in the competing event of death was detected.
conclusionsIn critically ill patients with RRT-dependent AKI, plasma penKid appears to be a useful biomarker for the prediction of shorter duration and successful liberation from RRT and may allow an individualized approach to guide strategies of RRT liberation in critically ill patients with RRT-dependent AKI.
trial registrationThe ELAIN trial was prospectively registered at the German Clinical Trial Registry (Identifier: DRKS00004367) on 28th of May 2013.
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