ACUTE KIDNEY INJURY IN 2018

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.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

Fig. 1: Reasons for optimism in AKI therapeutics.

References

  1. 1.

    Semler, M. W. et al. Balanced crystalloids versus saline in critically ill adults. N. Engl. J. Med. 378, 829–839 (2018).

    Article  PubMed  Google Scholar 

  2. 2.

    Self, W. H. et al. Balanced crystalloids versus saline in noncritically ill adults. N. Engl. J. Med. 378, 819–828 (2018).

    Article  PubMed  Google Scholar 

  3. 3.

    Kidney Disease: Improving Global Outcomes (KDIGO) Work Group. KDIGO clinical practice guildeline for acute kidney injury. Kidney Int. Suppl. 2, 1–138 (2012).

    Article  Google Scholar 

  4. 4.

    Kellum, J. A. Acute kidney injury: AKI: the myth of inevitability is finally shattered. Nat. Rev. Nephrol. 13, 140–141 (2017).

    Article  Google Scholar 

  5. 5.

    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).

    Article  Google Scholar 

  6. 6.

    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).

    Article  Google Scholar 

  7. 7.

    Guo, Y. et al. MicroRNA-709 mediates acute tubular injury through effects on mitochondrial function. J. Am. Soc. Nephrol. 29, 449–461 (2018).

    CAS  Article  Google Scholar 

  8. 8.

    Poyan Mehr, A. et al. De novo NAD+ biosynthetic impairment in acute kidney injury in humans. Nat. Med. 24, 1351–1359 (2018).

    CAS  Article  Google Scholar 

  9. 9.

    Katsyuba, E. et al. De novo NAD+ synthesis enhances mitochondrial function and improves health. Nature 563, 354–359 (2018).

    CAS  Article  Google Scholar 

  10. 10.

    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).

    Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to John A. Kellum.

Ethics declarations

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.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

Further reading

Search

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing