• Acidosis
• Acute kidney injury
• Lactate
• Survival

• Humans
• Male
• Female
• Middle Aged
• Acute Kidney Injury/therapy
• Acute Kidney Injury/mortality
• Acute Kidney Injury/blood
• Acute Kidney Injury/diagnosis
• Intensive Care Units/trends
• Retrospective Studies
• Renal Replacement Therapy/mortality
• Hyperlactatemia/mortality
• Hyperlactatemia/blood
• Hyperlactatemia/therapy
• Hyperlactatemia/diagnosis
• Critical Illness/mortality
• Critical Illness/therapy
• Aged
• Lactic Acid/blood
• Hospital Mortality

• Acute kidney injury
• Chronic kidney disease
• Mortality
• Surgery
• Vitamin D deficiency

• Humans
• Vitamin D Deficiency/complications
• Vitamin D Deficiency/mortality
• Male
• Female
• Renal Insufficiency, Chronic/surgery
• Renal Insufficiency, Chronic/complications
• Renal Insufficiency, Chronic/mortality
• Retrospective Studies
• Aged
• Middle Aged
• Postoperative Complications/etiology
• Postoperative Complications/mortality
• Postoperative Complications/epidemiology
• Acute Kidney Injury/etiology
• Vitamin D/blood
• Propensity Score
• Risk Factors
• Pneumonia/etiology

• Acute kidney injury
• Kuwait
• dialysis
• mortality
• socioeconomic disparity

• Acute kidney injury
• Long-term mortality
• Risk factors

• Humans
• Child, Preschool
• Retrospective Studies
• Veterans
• Creatinine
• Risk Factors
• Acute Kidney Injury/etiology

• R01 HL160734 NHLBI NIH HHS
• R56 HL158803 NHLBI NIH HHS

• Acute kidney injury
• Intensive care unit
• Prediction model
• Renal recovery
• Validation

• Humans
• Adult
• Lipocalin-2
• Critical Illness/therapy
• Patient Discharge
• Models, Statistical
• Prognosis
• Prospective Studies
• Acute Kidney Injury/diagnosis
• Biomarkers
• Sepsis
• Hospitals

• Acute Kidney Injury/etiology
• Albumins
• Creatine
• Creatinine
• Humans
• Intensive Care Units
• Prognosis
• Renal Dialysis
• Retrospective Studies
• Risk Factors
• Sepsis/complications

Acute kidney injury (AKI) occurs frequently in critically ill patients and is associated with adverse outcomes. Cellular mechanisms underlying AKI and kidney cell responses to injury remain incompletely understood.

We performed single-nuclei transcriptomics, bulk transcriptomics, molecular imaging studies, and conventional histology on kidney tissues from 8 individuals with severe AKI (stage 2 or 3 according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria). Specimens were obtained within 1–2 h after individuals had succumbed to critical illness associated with respiratory infections, with 4 of 8 individuals diagnosed with COVID-19. Control kidney tissues were obtained post-mortem or after nephrectomy from individuals without AKI.

High-depth single cell-resolved gene expression data of human kidneys affected by AKI revealed enrichment of novel injury-associated cell states within the major cell types of the tubular epithelium, in particular in proximal tubules, thick ascending limbs, and distal convoluted tubules. Four distinct, hierarchically interconnected injured cell states were distinguishable and characterized by transcriptome patterns associated with oxidative stress, hypoxia, interferon response, and epithelial-to-mesenchymal transition, respectively. Transcriptome differences between individuals with AKI were driven primarily by the cell type-specific abundance of these four injury subtypes rather than by private molecular responses. AKI-associated changes in gene expression between individuals with and without COVID-19 were similar.

The study provides an extensive resource of the cell type-specific transcriptomic responses associated with critical illness-associated AKI in humans, highlighting recurrent disease-associated signatures and inter-individual heterogeneity. Personalized molecular disease assessment in human AKI may foster the development of tailored therapies.

The online version contains supplementary material available at 10.1186/s13073-022-01108-9.

• Acute kidney injury
• Critical illness
• Single-cell sequencing

Inflammation plays a significant role in the occurrence and development of acute kidney injury (AKI). Evidence regarding the prognostic effect of the systemic immune-inflammation index (SII) in critically ill patients with AKI is scarce. The aim of this study was to assess the association between SII and all-cause mortality in these patients. Detailed clinical data were extracted from the Medical Information Mart for Intensive Care Database (MIMIC)-IV. The primary outcome was set as the in-hospital mortality. A total of 10,764 AKI patients were enrolled in this study. The restricted cubic splines analyses showed a J-shaped curve between SII and the risk of in-hospital and ICU mortality. After adjusting for relevant confounders, multivariate Cox regression analysis showed that both lower and higher SII levels were associated with an elevated risk of in-hospital all-cause mortality. A similar trend was observed for ICU mortality. In summary, we found that the SII was associated in a J-shaped pattern with all-cause mortality among critically ill patients with AKI. SII appears to be have potential applications in the clinical setting as a novel and easily accessible biomarker for predicting the prognosis of AKI patients.

Early prediction of long-term outcomes in patients with sepsis-induced cardiorenal syndrome (CRS) remains a great challenge in clinical practice. Herein, we aimed to construct a nomogram and machine learning model for predicting the 1-year mortality risk in patients with sepsis-induced CRS.

This retrospective study enrolled 340 patients diagnosed with sepsis-induced CRS in Shanghai Tongji Hospital between January 2015 and May 2019, as a discovery cohort. Two predictive models, the nomogram and machine learning model, were used to predict 1-year mortality. The prognostic variables used to develop the nomogram were identified based on a forward stepwise binary logistic regression, and the predictive ability of the nomogram was evaluated by the areas under the receiver operating characteristic curve (AUC) and the calibration curve. Meanwhile, machine learning (ML) techniques, such as support vector machine, random forest (RF), and gradient boosted decision tree, were assessed mainly by accuracy and AUC. Feature ranking analysis was performed using the ML algorithm. Both nomogram and ML models were externally validated by an independent cohort of 103 patients diagnosed with sepsis-induced CRS between June 2019 and December 2020.

Age, sequential sepsis-related organ failure score (SOFA), serum myoglobin (MYO), vasopressor use, and mechanical ventilation were identified as independent risk factors for 1-year mortality in the nomogram predictive model. In the discovery cohort, the nomogram yielded higher AUC for predicting mortality than did the SOFA score (0.855 [95% CI: 0.815–0.895] vs. 0.756 [95% CI: 0.705–0.808]). For ML, the model developed by RF showed the highest accuracy (0.765) and AUC (0.854). In feature ranking analysis, factors such as age, MYO, SOFA score, vasopressor use, and baseline serum creatinine were identified as important features affecting 1-year prognosis. Moreover, the nomogram and RF model both performed well in external validation, with an AUC of 0.877 and 0.863, respectively.

Our nomogram and ML models showed that age, SOFA score, serum MYO levels, and the use of vasopressors during hospitalization were the main factors influencing the risk of long-term mortality. Our models may serve as useful tools for assessing long-term prognosis in patients with sepsis-induced CRS.

• National Natural Science Foundation of China

• acute kidney injury
• acute kidney injury and ICU nephrology
• critical care
• dialysis
• prognostic model
• survival

• Acute Kidney Injury/therapy
• Aged
• Critical Illness/therapy
• Hospitals
• Humans
• Middle Aged
• Renal Dialysis
• Renal Insufficiency, Chronic
• Retrospective Studies

Prognosis of survivors from cardiac arrest is generally poor. Acute kidney injury (AKI) is a common finding in these patients. In general, AKI is well characterized as a marker of adverse outcome. In-hospital cardiac arrest (IHCA) represents a special subset of cardiac arrest scenarios with differential predisposing factors and courses after the event, compared to out-of-hospital resuscitations. Data about AKI in survivors after in-hospital cardiac arrest are scarce.

In this study, we retrospectively analyzed patients after IHCA for incidence and risk factors of AKI and its prognostic impact on mortality. For inclusion in the analysis, patients had to survive at least 48 h after IHCA.

A total of 238 IHCA events with successful resuscitation and survival beyond 48 h after the initial event were recorded. Of those, 89.9% were patients of internal medicine, and 10.1% of patients from surgery, neurology or other departments. In 120/238 patients (50.4%), AKI was diagnosed. In 28 patients (23.3%), transient or permanent renal replacement therapy had to be initiated. Male gender, preexisting chronic kidney disease and a non-shockable first ECG rhythm during resuscitation were significantly associated with a higher incidence of AKI in IHCA-survivors. In-hospital mortality in survivors from IHCA without AKI was 29.7%, and 60.8% in patients after IHCA who developed AKI (p < 0.01 between groups).

By multivariate analysis, AKI after IHCA persisted as an independent predictor of in-hospital mortality (HR 3.7 (95% CI 2.14–6.33, p ≤ 0.01)).

In this cohort of survivors from IHCA, AKI is a frequent finding, with adverse impact on outcome. Therefore, therapeutic strategies to prevent AKI in post-IHCA patients are warranted.

• In-hospital cardiac arrest
• acute kidney injury
• hemodialysis
• prognosis

Both acute and chronic kidney disease have a strong underlying inflammatory component. This review focuses primarily on T helper 17 (Th17) cells as mediators of inflammation and their potential to modulate acute and chronic kidney disease. We provide updated information on factors and signaling pathways that promote Th17 cell differentiation with specific reference to kidney disease. We highlight numerous clinical studies that have investigated Th17 cells in the setting of human kidney disease and provide updated summaries from various experimental animal models of kidney disease indicating an important role for Th17 cells in renal fibrosis and hypertension. We focus on the pleiotropic effects of Th17 cells in different renal cell types as potentially relevant to the pathogenesis of kidney disease. Finally, we highlight studies that present contrasting roles for Th17 cells in kidney disease progression.

• Acute kidney injury
• Hypertension
• Inflammation
• Renal fibrosis

Elevated plasma C-terminal fibroblast growth factor-23 (cFGF-23) levels are associated with higher mortality in patients with chronic kidney disease (CKD) and acute kidney injury (AKI). Our study explored the outcome forecasting accuracy of cFGF-23 in critically ill patients with CKD superimposed with AKI (ACKD).

Urine and plasma biomarkers from 149 CKD patients superimposed with AKI before dialysis were checked in this multicenter prospective observational cohort study. Endpoints were 90-day mortality and 90 days free from dialysis after hospital discharge. Associations with study endpoints were assessed using hierarchical clustering analysis, the generalized additive model, the Cox proportional hazard model, competing risk analysis, and discrimination evaluation.

Over a median follow up of 40 days, 67 (45.0%) patients died before the 90th day after hospital discharge and 39 (26.2%) progressed to kidney failure with replacement therapy (KFRT). Hierarchical clustering analysis demonstrated that cFGF-23 levels had better predictive ability for 90-day mortality than did other biomarkers. Higher serum cFGF-23 levels were independently associated with greater risk for 90-day mortality [hazard ratio (HR): 2.5; 95% confidence interval (CI) 1.5–4.1; p < 0.001]. Moreover, adding plasma cFGF-23 to the Demirjian AKI risk score model substantially improved risk prediction for 90-day mortality than the Demirjian model alone (integrated discrimination improvement: 0.06; p < 0.05; 95% CI 0.02–0.10). The low plasma cFGF-23 group was predicted having more weaning from dialysis in surviving patients (HR = 0.53, 95% CI, 0.29–0.95, p = 0.05).

In patients with ACKD, plasma cFGF-23 levels are an independent risk factor to forecast 90-day mortality and 90-day progression to KFRT. In combination with the clinical risk score, plasma cFGF-23 levels could substantially improve mortality risk prediction.

• acute kidney injury
• biomarker
• chronic kidney disease
• fibroblast growth factor-23
• mortality
• neutrophil gelatinase-associated lipocalin
• renal replacement therapy

• acute kidney injury
• amino acids
• chronic kidney disease
• glomerular filtration rate
• renal blood flow

Acute kidney disease (AKD) is a state between acute kidney injury (AKI) and chronic kidney disease (CKD), but the prognosis of AKD is unclear and there are no risk-prediction tools to identify high-risk patients. 2,556 AKI patients were selected from 277,898 inpatients of three affiliated hospitals of Central South University from January 2015 to December 2015. The primary point was whether AKI patients developed AKD. The endpoint was death or end stage renal disease (ESRD) 90 days after AKI diagnosis. Multivariable Cox regression was used for 90-day mortality and two prediction models were established by using multivariable logistic regression. Our study found that the incidence of AKD was 53.17% (1,359/2,556), while the mortality rate and incidence of ESRD in AKD cohort was 19.13% (260/1,359) and 3.02% (41/1,359), respectively. Furthermore, adjusted hazard ratio of mortality for AKD versus no AKD was 1.980 (95% CI 1.427–2.747). In scoring model 1, age, gender, hepatorenal syndromes, organic kidney diseases, oliguria or anuria, respiratory failure, blood urea nitrogen (BUN) and acute kidney injury stage were independently associated with AKI progression into AKD. In addition, oliguria or anuria, respiratory failure, shock, central nervous system failure, malignancy, RDW-CV ≥ 13.7% were independent risk factors for death or ESRD in AKD patients in scoring model 2 (goodness-of fit, P₁ = 0.930, P₂ = 0.105; AUROC₁ = 0.879 (95% CI 0.862–0.896), AUROC₂ = 0.845 (95% CI 0.813–0.877), respectively). Thus, our study demonstrated AKD was independently associated with increased 90-day mortality in hospitalized AKI patients. A new prediction model system was able to predict AKD following AKI and 90-day prognosis of AKD patients to identify high-risk patients.

• AKI risk
• Acute kidney injury (AKI)
• IL-18
• KIM-1
• MCP-1
• NGAL
• [TIMP-2] × [IGFBP-7]
• algorithm implementation
• biomarker assessment
• electronic health record (EHR)
• hospitalized patients
• inpatient mortality
• kidney injury marker
• prediction
• prognostic model
• prospective
• renal function trajectory
• serum creatinine (Scr)

• Anti-inflammatory reflex
• Inflammation
• Kidney injury
• Neuroimmunomodulation
• Vagus

• acute kidney injury
• alerts
• algorithm
• epidemiology
• hospital

• N-terminal pro-B-type natriuretic peptide
• acute kidney injury
• biomarker
• mortality
• renal replacement therapy

• Acute kidney injury
• Dialysis
• Prediction model
• Renal recovery
• Renal replacement therapy

We investigated the association between preoperative proteinuria and early postoperative renal function after robotic partial nephrectomy (RPN).

We retrospectively reviewed 1121 consecutive RPN cases at a single academic center from 2006 to 2016. Patients without pre-existing CKD (eGFR≥60 mL/min/1.73m²) who had a urinalysis within 1-month prior to RPN were included. The cohort was categorized by the presence or absence of preoperative proteinuria (trace or greater (≥1+) urine dipstick), and groups were compared in terms of clinical and functional outcomes. The incidence of acute kidney injury (AKI) was assessed using RIFLE criteria. Univariate and multivariable models were used to identify factors associated with postoperative AKI.

Of 947 patients, 97 (10.5%) had preoperative proteinuria. Characteristics associated with preoperative proteinuria included non-white race (p<0.01), preoperative diabetes (p<0.01) and hypertension (HTN) (p<0.01), higher ASA (p<0.01), higher BMI (p<0.01), and higher Charlson score (p<0.01). The incidence of AKI was higher in patients with preoperative proteinuria (10.3% vs. 4.6%, p=0.01). The median eGFR preservation measured within one month after surgery was lower (83.6% vs. 91%, p=0.04) in those with proteinuria; however, there were no significant differences by 3 months after surgery or last follow-up visit. Independent predictors of AKI were high BMI (p<0.01), longer ischemia time (p<0.01), and preoperative proteinuria (p=0.04).

Preoperative proteinuria by urine dipstick is an independent predictor of postoperative AKI after RPN. This test may be used to identify patients, especially those without overt CKD, who are at increased risk for developing AKI after RPN.

• Acute Kidney Injury
• Kidney Neoplasms
• Proteinuria

• 9th Revision
• Clinical Modification (ICD-9-CM)
• International Classification of Diseases
• acute kidney injury
• comorbidity
• in-hospital mortality

• Acute Kidney Injury/mortality
• Aged
• Female
• Germany/epidemiology
• Hospital Mortality
• Humans
• Incidence
• Male
• Middle Aged
• Retrospective Studies
• Risk Factors

• Acute kidney injury
• Haemorrhagic shock
• Platelet count
• biomarker
• mortality

• Acute kidney injury
• Acute renal failure
• Chronic kidney disease
• Definition
• Définition
• Epidemiology
• Facteurs de risque
• Incidence
• Insuffisance rénale aiguë
• Maladie rénale chronique
• Mortality
• Mortalité
• Risk factor
• Épidémiologie

• Acute Kidney Injury/classification
• Acute Kidney Injury/diagnosis
• Acute Kidney Injury/drug therapy
• Acute Kidney Injury/epidemiology
• Biomarkers/blood
• Critical Care/standards
• Early Diagnosis
• Humans
• Kidney/injuries
• Kidney/microbiology
• Kidney/pathology
• Male
• Middle Aged
• Outcome Assessment, Health Care
• Practice Guidelines as Topic/standards
• Risk Factors
• Sepsis/complications
• Sepsis/epidemiology
• Sepsis/mortality
• Sepsis/prevention & control

• R21 DK113420 NIDDK NIH HHS

Aging is a global phenomenon. Recent forecasts indicate that Brazil will be the sixth country in population of elderly individuals in 2020. The incidence of acute kidney injury (AKI) among the elderly varies, but studies have indicated that older individuals are more prone to developing AKI and have higher mortality rates than the general population with renal disease. The impact of dialysis in elderly patients with AKI - and critically ill individuals with multiple dysfunctions - has been discussed for years. Evidence indicates that for this group of patients dialysis does not positively impact survival and, in some situations, it might even accelerate death. This study investigated a population of elderly individuals with AKI seen in intensive care units to assess, through Propensity Score Matching, the impact dialysis has had for them.

Data from the charts of patients aged 60 years or older seen at the intensive care unit of a general hospital between January 2012 and December 2014 and diagnosed with AKI were collected.

The study included 329 patients with a mean age of 75.4 ± 9.3 years. Ischemic AKI was the most prevalent disease (54.7%) and 28.9% of the patients needed dialysis. No difference was seen in the death rates of dialysis and non-dialysis patients aged 70+ years.

The data suggested that dialysis did not seem to impact the death rates of critically ill patients with AKI aged 70+ years.

• acute kidney injury
• clinical research
• critical care
• feasibility trial
• fluid accumulation
• fluid overload
• forced fluid removal

Chronic kidney disease (CKD) and acute kidney injury (AKI) are strongly associated with excess morbidity and mortality and frequently co-occur in critically ill septic patients, but how their interplay affects clinical outcomes is not well elucidated.

We conducted a single-center, retrospective cohort study of 2632 adult patients admitted to the intensive care unit (ICU) with severe sepsis or septic shock. Subjects were classified into 6 groups according to baseline CKD (no-CKD: estimated glomerular filtration rate [eGFR] ≥60; CKD: eGFR 15−59 ml/min per 1.73 m²) and incident AKI by the Kidney Disease: Improving Global Outcomes (KDIGO) serum creatinine criteria (no-AKI, AKI stage 1, AKI stages ≥2) during ICU stay. Study outcomes were 90-day mortality (in hospital or within 90 days of discharge) and incident/progressive CKD.

Prevalent CKD was 46% and incident AKI was 57%. Adjusted hazard ratios (95% confidence intervals) for 90-day mortality relative to the reference group of no-CKD/no-AKI were 1.5 (1.1−2.0) in no-CKD/AKI stage 1, 2.4 (1.9−3.1) in no-CKD/AKI stages≥2, 1.1 (0.8−1.4) in CKD/no-AKI, 1.2 (0.9−1.6) in CKD/AKI stage 1, and 2.2 (1.7−2.9) in CKD/AKI stages ≥2. A similar trend was observed for incident/progressive CKD during a median follow-up of 15.3 months.

Stage 1 AKI on CKD was not associated with an independent increased risk of adverse outcomes in critically ill septic patients. AKI stages ≥2 on CKD and any level of AKI in no-CKD patients were strongly and independently associated with adverse outcomes. Sepsis-associated stage 1 AKI on CKD may represent distinct underlying pathophysiology, with more prerenal cases and less severe de novo intrinsic damage, which needs further investigation.

• AKI
• CKD
• mortality
• outcomes
• sepsis

• Acute kidney injury
• Continuous renal replacement therapy
• Mean platelet volume
• Mortality
• Platelet Count

Acute kidney injury (AKI) is a challenging problem faced by intensive care clinicians worldwide, and it is associated with high morbidity and mortality, especially in critically ill patients.

A hospital-based prospective, observational study was conducted in patients of AKI admitted to the Intensive Care Unit (ICU) of the Department of Medicine in a rural tertiary care hospital located in central India. Data of all consecutive AKI inpatients related to demographic variables, clinical profile, and laboratory investigations were collected from patient's medical records.

Of the total 229 AKI patients enrolled in this study, 65 (28.4%) patients died during their hospital stay. The presence of metabolic acidosis, hypotension, Glasgow coma scale (GCS) and Acute Physiologic Assesment and Chronic Health Evaluation (APACHE 2) score, advanced AKI stage, higher serum creatinine and blood urea levels on diagnosis of AKI and the peak rise in their level within 48 h of diagnosis of AKI, the use of mechanical ventilator, leukocytosis, and hyperkalemia were significantly associated with in-hospital mortality in AKI patients (P < 0.05).

The overall in-hospital mortality in patients of AKI admitted to medicine-ICU was 28.4%. Sepsis was the most common cause of AKI (24.5%). The presence of metabolic acidosis, hypotension, GCS and APACHE 2 score, advanced AKI stage, higher serum creatinine, and blood urea levels on diagnosis of AKI and the peak rise in their level within 48 h of diagnosis of AKI, use of mechanical ventilator, leukocytosis, and hyperkalemia were associated with in-hospital mortality in AKI patients.

• Acute kidney injury
• etiology
• incidence
• mortality
• predictors

• Acute kidney injury
• Intensive care unit
• Platelet-to-lymphocyte ratio
• Prognosis

• Acute Kidney Injury/blood
• Acute Kidney Injury/diagnosis
• Adult
• Aged
• Aged, 80 and over
• Biomarkers/analysis
• Biomarkers/blood
• Female
• Humans
• Intensive Care Units/organization & administration
• Intensive Care Units/statistics & numerical data
• Kaplan-Meier Estimate
• Lymphocyte Count/methods
• Lymphocyte Count/standards
• Male
• Middle Aged
• Platelet Count/methods
• Platelet Count/standards
• Prognosis
• Proportional Hazards Models

• Acute kidney injury
• Cell therapy
• Lipocalin 2
• Mesenchymal stem cells

• Acute kidney injury
• Blood pressure
• Extremely low birth weight
• Serum creatinine

• Acute Kidney Injury/blood
• Acute Kidney Injury/complications
• Acute Kidney Injury/epidemiology
• Age Factors
• Blood Pressure Determination
• Case-Control Studies
• Child
• Child, Preschool
• Creatinine/blood
• Female
• Follow-Up Studies
• Hospitalization
• Humans
• Hypertension/blood
• Hypertension/epidemiology
• Hypertension/etiology
• Incidence
• Infant
• Infant, Extremely Low Birth Weight
• Infant, Newborn
• Intensive Care Units, Neonatal/statistics & numerical data
• Length of Stay
• Male
• Patient Discharge
• Prevalence
• Retrospective Studies

Urine neutrophil gelatinase-associated lipocalin (uNGAL) is a sensitive and specific diagnostic test for acute kidney injury (AKI) in the Emergency Department (ED), but its economic impact has not been investigated. We hypothesized that uNGAL used in combination with serum creatinine (sCr) would reduce costs in the management of AKI in patients presenting to the ED in comparison to using sCr alone.

A cost simulation model was developed for clinical algorithms to diagnose AKI based on sCr alone vs. uNGAL plus sCr (uNGAL+sCr). A cost minimization analysis was performed to determine total expected costs for patients with AKI. uNGAL test characteristics were validated with eight-hundred forty-nine patients with sCr ≥1.5 from a completed study of 1635 patients recruited from EDs at two U.S. hospitals from 2007–8. Biomarker test, AKI work-up, and diagnostic imaging costs were incorporated.

For a hypothetical cohort of 10,000 patients, the model predicted that the expected costs were $900 per patient (pp) in the sCr arm and $950 in the uNGAL+sCr arm. uNGAL+sCr resulted in 1,578 fewer patients with delayed diagnosis and treatment than sCr alone (2,013 vs. 436 pts) at center 1 and 1,973 fewer patients with delayed diagnosis and treatment than sCr alone at center 2 (2,227 vs. 254 patients). Although initial evaluation costs at each center were $50 pp higher in with uNGAL+sCr, total costs declined by $408 pp at Center 1 and by $522 pp at Center 2 due to expected reduced delays in diagnosis and treatment. Sensitivity analyses confirmed savings with uNGAL + sCr for a range of cost inputs.

Using uNGAL with sCr as a clinical diagnostic test for AKI may improve patient management and reduce expected costs. Any cost savings would likely result from avoiding delays in diagnosis and treatment and from avoidance of unnecessary testing in patients given a false positive AKI diagnosis by use of sCr alone.