New Guidance on Diagnosing and Managing Acute Kidney Injury 

WASHINGTON (May 11, 2021)—Over the past decade, experts’ understanding of testing for acute kidney injury (AKI) has evolved significantly, but current medical practice has not yet caught up with the latest research in this area. The American Association for Clinical Chemistry (AACC) has therefore issued a new guidance document on AKI that provides laboratory and other health care professionals with the most up to date best practices for diagnosing and managing this potentially fatal condition.

AKI, which is defined as a sudden episode of kidney damage or failure, is a condition that affects up to 15 percent of hospitalized patients and can lead to serious complications or death. A wide range of causes can trigger AKI—from major surgical procedures to medications that affect kidney function—and its symptoms can vary depending on the underlying cause, making it a challenging condition to diagnose and treat. It is therefore essential that clinical laboratory professionals and clinicians know what the right tools are for diagnosing AKI. However, current approaches to detecting this condition differ widely throughout the medical community due to factors such as inconsistent integration of new findings on AKI into clinical practice. This has led to considerable disparities in the identification and management of AKI around the world, and underscores the need for a uniform set of best practices on testing for this condition.

To improve AKI patient care and outcomes, a multidisciplinary group of clinical laboratory experts and nephrologists formed by AACC’s Academy have developed evidence-based guidance on laboratory testing for AKI. One of the guidance’s major recommendations addresses a shortcoming of the current criteria for diagnosing AKI with creatinine testing (the primary test for this condition), which were established by the 2012 Kidney Disease Improving Global Outcomes (KDIGO) guidelines. Recent studies have linked use of the KDIGO diagnostic criteria with a high rate of false-positive AKI diagnoses. To remedy this, AACC’s guidance proposes using new diagnostic thresholds, known as the 20/20 AACC AKI criteria, to determine whether a patient has AKI with creatinine testing. The use of these new criteria is supported by strong evidence from a study of 14,912 adult patients.

AACC’s guidance document also covers the following: 

• when to test for AKI 
• other best practices for creatinine testing
• the utility of other tests used to identify the cause of AKI and guide treatment, and 
• the utility of new tests for AKI, including a machine learning-based approach for predicting the development of this condition in patients.

“Our understanding of and tools used for detecting AKI have both evolved since KDIGO was published in 2012,” said the guidance’s lead authors, Drs. Joe M. El-Khoury and Chirag R. Parikh. “The information and opinions provided within this document are intended to shed light on the current status of the field and generate a healthy debate with clinical organizations that leads to a much-needed update to our current practice of investigating AKI. Clinicians and laboratorians should work together to implement [our findings and recommendations].”

- This press release was provided by AACC