With many failures, a sense of helplessness has overshadowed the field of acute kidney injury (AKI). Publications in 2018 offer new hope: better drug targets, better end points and improved understanding of conditions that cause AKI and its complications bring promise that a drug will soon be available.
Key advances
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The risk of acute kidney injury (AKI) and adverse kidney events in hospitalized patients can be reduced by using physiological solutions instead of saline for intravenous fluid therapy1,2.
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Strategies for the enrichment and subcategorization of patients with AKI who are most likely to benefit from specific treatments are now available5,8.
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New mechanisms and related drug targets, most notably related to mitochondrial dysfunction, have transformed the therapeutic landscape of AKI7,8,9.
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End points for use in trials of AKI therapies are now well defined1,2,5,10.
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References
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Kellum, J. A. Acute kidney injury: AKI: the myth of inevitability is finally shattered. Nat. Rev. Nephrol. 13, 140–141 (2017).
Husain-Syed, F. et al. Preoperative renal functional reserve predicts risk of acute kidney injury after cardiac operation. Ann. Thorac. Surg. 105, 1094–1101 (2018).
Husain-Syed, F. et al. Persistent decrease of renal functional reserve in patients after cardiac surgery-associated acute kidney injury despite clinical recovery. Nephrol. Dial.Transplant. https://doi.org/10.1093/ndt/gfy227 (2018).
Guo, Y. et al. MicroRNA-709 mediates acute tubular injury through effects on mitochondrial function. J. Am. Soc. Nephrol. 29, 449–461 (2018).
Poyan Mehr, A. et al. De novo NAD+ biosynthetic impairment in acute kidney injury in humans. Nat. Med. 24, 1351–1359 (2018).
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Alobaidi, R. et al. Association between fluid balance and outcomes in critically ill children: a systematic review and meta-analysis. JAMA Pediatr. 172, 257–268 (2018).
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J.A.K. has received grant support and consulting fees from Astute Medical and TES Pharma. D.Y.F. declares no competing interests.
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Kellum, J.A., Fuhrman, D.Y. The handwriting is on the wall: there will soon be a drug for AKI. Nat Rev Nephrol 15, 65–66 (2019). https://doi.org/10.1038/s41581-018-0095-2
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DOI: https://doi.org/10.1038/s41581-018-0095-2
