This systematic evidence map screened 6,805 records and included 1,116 studies of novel biomarkers of acute kidney injury in critically ill patients. Most (78.6%) enrolled adults, and 93.3% were cohort studies. Mixed ICU populations, cardiac surgery and sepsis were the commonest settings.
Most studies asked whether a biomarker predicts AKI (944) or prognosis (647). Far fewer addressed diagnosing the cause (109), enriching trials (6) or managing AKI (12). The authors suggest practical uses in surveillance of patients at risk, such as those having surgery or exposed to several nephrotoxic drugs.
An evidence map describes what exists; it does not weigh effect sizes or judge quality, and it cannot say that any biomarker improves outcomes. Most of these tests are not available in routine Indian ICUs, where serum creatinine and urine output remain the working tools.
- Keep using creatinine trend and urine output as the working definition of AKI.
- Review nephrotoxic drugs daily in patients at risk, whatever biomarkers are available.
- Do not order novel biomarkers where the result would not change management.
- Look for trial evidence of benefit, not only accuracy, before adopting a test.
Why it matters
It shows the gap between a test that predicts kidney injury and one that improves care.
Don't overread it
A map of study counts does not assess effect sizes or study quality, so it does not show that any biomarker works.
The statistics, in plain English
An evidence map counts how many studies address each question. A large count means the question has been studied, not that the answer is established, and 944 studies on prediction against 12 on management shows where evidence is thin.
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