Früher erkennen: Prädiktoren und Alerts bei AKI

The basis for early treatment of acute kidney injury (AKI) is its early detection in the routine clinical practice. In recent years a number of innovative approaches have been developed aiming to treat AKI earlier and more effectively and therefore to reduce the associated significant morbidity and mortality. First, computational algorithms for early detection of AKI have been introduced, exploiting available clinical data, such as the temporal patterns of serum creatinine levels. These algorithms were then linked to electronic alert (e-Alert) systems to inform healthcare providers via hospital information systems and to trigger clinical measures. Secondly, several novel blood or urine biomarkers, such as tissue inhibitor of metalloproteinases 2 (TIMP-2), insulin-like growth factor binding protein 7 (IGFBP-7), kidney injury molecule 1 (KIM-1) or neutrophil gelatinase-associated lipocalin (NGAL), have been identified that can detect AKI even before changes in creatinine dynamics occur. This article summarizes the current state of these novel approaches for early detection of AKI. It also addresses the challenges of the optimal implementation and integration of such methods into routine clinical treatment practice and discusses the scientific evidence regarding their effectiveness and safety.