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The handwriting is on the wall: there will soon be a drug for AKI

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

  • 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.

  • Strategies for the enrichment and subcategorization of patients with AKI who are most likely to benefit from specific treatments are now available5,8.

  • New mechanisms and related drug targets, most notably related to mitochondrial dysfunction, have transformed the therapeutic landscape of AKI7,8,9.

  • End points for use in trials of AKI therapies are now well defined1,2,5,10.

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Fig. 1: Reasons for optimism in AKI therapeutics.


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Correspondence to John A. Kellum.

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Competing interests

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).

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