Paulin S, Palaniappan R. Brain-kidney cross-talk: A call for action! World J Crit Care Med 2026; 15(2): 115116 [PMID: 42272885 DOI: 10.5492/wjccm.v15.i2.115116]
Corresponding Author of This Article
Susan Paulin, Consultant, Department of Liver Transplant Anesthesia and Critical Care, Dr Rela Institute and Medical Centre, No. 7 CLC works road, Nagappa Nagar, Chrompet, Chennai 600044, Tamil Nādu, India. susanvercetti@gmail.com
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Critical Care Medicine
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editorial
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Paulin S, Palaniappan R. Brain-kidney cross-talk: A call for action! World J Crit Care Med 2026; 15(2): 115116 [PMID: 42272885 DOI: 10.5492/wjccm.v15.i2.115116]
World J Crit Care Med. Jun 9, 2026; 15(2): 115116 Published online Jun 9, 2026. doi: 10.5492/wjccm.v15.i2.115116
Brain-kidney cross-talk: A call for action!
Susan Paulin, Ratthinam Palaniappan
Susan Paulin, Department of Liver Transplant Anesthesia and Critical Care, Dr Rela Institute and Medical Centre, Chennai 600044, Tamil Nādu, India
Ratthinam Palaniappan, Department of Critical Care Medicine, Dr Rela Institute and Medical Centre, Chennai 600044, Tamil Nādu, India
Author contributions: Paulin S and Palaniappan R contributed to the writing and editing of the manuscript, illustrations, and review of literature; Paulin S designed the overall concept and outline of the manuscript; Palaniappan R contributed to the discussion and design of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Susan Paulin, Consultant, Department of Liver Transplant Anesthesia and Critical Care, Dr Rela Institute and Medical Centre, No. 7 CLC works road, Nagappa Nagar, Chrompet, Chennai 600044, Tamil Nādu, India. susanvercetti@gmail.com
Received: October 9, 2025 Revised: December 9, 2025 Accepted: January 19, 2026 Published online: June 9, 2026 Processing time: 224 Days and 19.5 Hours
Abstract
The cascade of events initiated by traumatic brain injury (TBI) has been a major focus of research. Despite significant advances, a deeper understanding of both favorable and unfavorable factors is still needed in this special cohort, especially concerning non-neurological complications - such as respiratory dysfunction, cardiovascular issues, sepsis, and acute kidney injury (AKI). This underscores the need to look beyond the immediate “what kills first” approach and address other critical problems that are essential for both patient management and resource utilization. The brain-kidney cross-talk goes both ways. In this context, Wankhade et al recently published a study in World Journal of Critical Care Medicine, investigating the risk factors that predict the development of AKI following TBI, and the most frequently recognized contributors. TBI can lead to AKI through several pathways, while conversely, AKI can worsen brain injury. While the pathophysiology is increasingly understood, there are limited interventions to prevent AKI in TBI patients. So does identification of predictors and risk factors translate to prevention of AKI here? A precise understanding is needed to help develop targeted interventions rather than just reactive treatments. The search for predictive biomarkers is a promising area of research, especially with regard to early identification of non-neurological complications. Future research must shift towards the development of predictive biomarkers and targeted preventive strategies, ensuring extension of clinical focus beyond immediate life threats and addressing the full spectrum of TBI-related pathophysiology.
Core Tip: Optimal management of traumatic brain injury requires moving beyond immediate neurological threats to address the profound systemic complications that often determine patient outcomes. The critical question remains: Does identification of predictors translate into effective prevention? A call for action is needed in refining hemodynamic targets, utilization of advanced hemodynamic monitoring, exploring predictive biomarkers, and developing Artificial Intelligence-based prediction models. Clinical focus must expand beyond the immediate neurological threats to address the full spectrum of traumatic brain injury pathophysiology to develop integrated, multi-organ therapeutic strategies and enhance patient outcomes with efficient resource utilization.
