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. Author manuscript; available in PMC: 2021 Dec 1.
Published in final edited form as: Anesth Analg. 2020 Dec;131(6):1679–1692. doi: 10.1213/ANE.0000000000005107

Table 3.

Biomarkers-Guided Strategy and Interventions

PrevAKI trial (Meersch et al90)

  • Avoid nephrotoxic agents.

  • Discontinue ACEi/ARBs for the first 48 h after surgery.

  • Close monitoring of sCr and urinary output.

  • Avoid hyperglycemia for the first 72 h.

  • Evaluate alternatives to contrast agents.

  • Close hemodynamic monitoring using PICCO catheter to optimize the volume status and hemodynamic parameters using a predefined algorithm.

BigpAK study (Göcze et al131)

  • Increased continuous intravenous fluid administration for 6 h guided by central venous pressure and fluid responsiveness test.

  • Nephrology consultation to adjust medications and management of acid-base, electrolyte, and albumin status.

AKRT study (Engelman et al132)
[TIMP-2]•[IGFBP7] <0.3 (“fast track recovery”)

  • Remove Foley catheter, arterial line, central line.

  • May use ACEi/ARBs.

  • Consider holding diuretic if Toradol used.

  • Transfusion threshold Hb <7.0 g/dL.

  • Check sCr daily.

[TIMP-2]•[IGFBP7] ≥0.3 and ≤2.0

  • Keep Foley and monitor UO hourly.

  • Transfer to telemetry.

  • Avoid nephrotoxic agents (ACEi/ARBs, NSAIDs, vancomycin, gentamycin).

  • Transfusion threshold Hb <7.0 g/dL, unless oliguric.

  • If oliguria (UO <0.5 mL/kg/h per 3 h), activate AKRT/nephrology consult.

  • Use lactated Ringer’s solution for bolus.

  • Hold diuretics unless presence of pulmonary edema.

  • Repeat [TIMP-2]•[IGFBP7] in 24 h.

[TIMP-2]•[IGFBP7] >2.0

  • Activate AKRT.

  • Keep Foley and monitor UO hourly.

  • Maintain hemodynamic monitoring.

  • Avoid nephrotoxic agents (ACEi/ARBs, NSAIDs, vancomycin, gentamycin).

  • Adjust medication for renal function.

  • Goal-directed therapy.

  • Reassess transfusion threshold.

  • Nephrology consult.

  • Hold diuretics unless presence of pulmonary edema.

  • Repeat [TIMP-2]•[IGFBP7] in 24 h.

Abbreviations: ACEi, angiotensin-converting enzyme inhibitors; AKRT, acute kidney response team; ARBs, angiotensin receptor blockers; BigpAK, Biomarker Guided Intervention for Prevention of Acute Kidney Injury; Hb, hemoglobin; IGFBP7, insulin-like growth factor–binding protein 7; NSAIDs, nonsteroidal anti-inflammatory drugs; PICCO, Pulse index Contour Cardiac Output; PrevAKI, Prevention of cardiac surgery-associated AKI by implementing the KDIGO guidelines in high risk patients identified by biomarkers; sCr, serum creatinine; TIMP-2, tissue inhibitor of metalloproteinases-2; UO, urinary output.