JAMA: Astute Medical Dx assists in acute kidney injury prevention

A recent study found that AKI patients had a 30% mortality rate at one year, twice that of a heart attack.  The condition can lead to sepsis and other dangerous diseases.  As the only FDA-cleared diagnostic for AKI, the NephroCheck enables doctors to take action against the injury earlier.  For instance, remote ischemic preconditioning cuts the absolute risk of AKI by 15% following a randomized clinical trial of 240 patients, according to the study.

“Preconditioning-mediated protection is a phenomenon in which tissue, once exposed to a specific type of insult, will be protected from injury during a repeated similar or sometimes dissimilar insult,” two doctors from Baylor College of Medicine write in a JAMA editorial on the study.  “For instance, in experimental mouse/rat models of ischemia/reperfusion kidney injury, in which bilateral kidney pedicles (arteries and veins) are clamped for 30 to 45 minutes, AKI develops within 24 hours; invariably, kidney function recovers within a week.  However, if the kidneys are subjected to an equivalent insult 1 or 2 weeks after the initial insult, an equal increase in serum creatinine or kidney inflammation markers compared with the initial insult is not observed.”

Ischemia involves injuring an organ (though not too severely) by restricting blood to that part of the body.  The authors write that through a mysterious mechanism “ischemia in one organ is accompanied with protective changes in distant organs, a phenomenon known as remote ischemic preconditioning.”  Using the NephroCheck test and other indicators, the doctors were able to confirm that when they temporarily stopped blood flow into the arm of the trial patients, remote ischemic preconditioning also protected the kidney against injury following cardiopulmonary bypass, a surgery that often leads to AKI.

Study watchers says the study offers further validation of the two biomarkers measured by the NephroCheck, tissue inhibitor of metalloproteinase 2 and insulin-like growth factor binding protein 7.  Moreover, the manufacturer would be in for a big payday if remote ischemic preconditioning becomes the standard of care to ward off AKI, for its likely that the NephroCheck would be integrated into that treatment paradigm.

The company says that “results of the study suggest that such testing could someday play a role in the optimization of preventative therapies for AKI.”  “Suddenly, we have opened several new doors in the field of AKI, which has not previously seen a breakthrough of this caliber,” said study co-author Dr. John Kellum of the University of Pittsburgh, in the manufacturer’s release about the study.  “To validate a new treatment is exciting enough, but equally intriguing is the performance of two biomarkers, which may be useful in gauging the efficacy of treatment.”

REFERENCE:  Fierce Medical Devices; 29 MAY 2015; Varun Saxena

Leave a Comment