The Clinical Utility of Kidney Injury Molecule 1 in the Prediction, Diagnosis and Prognosis of Acute Kidney Injury: A Systematic Review

Abstract

This systematic review evaluates the clinical utility of a novel biomarker kidney injury molecule 1 (Kim-1) in the prediction, diagnosis and prognosis of acute kidney injury (AKI). We searched literature in electronic databases from January 2002 to December 2009 by the key words "kidney injury molecule 1" or "Kim-1" and "acute kidney injury" or "acute renal failure". Studies were eligible for inclusion if they were primary studies published in English, in which Kim-1 was measured for the purpose of prediction, diagnosis or prognosis of AKI in patients. Eight articles met the selection criteria for inclusion in the study. Compared to non AKI patients, Kim-1 increased significantly (at least p<0.05) in AKI patients by 2 hours after cardiac surgery. In the prediction of AKI in patients within 24 hours of cardiac surgery, the sensitivity of Kim-1 ranged from 92% to 100% and AUC between 0.78 and 0.91. Kim-1 increased significantly (at least p<0.05) in AKI established patients, especially in patients with acute tubular necrosis (ATN). The AUC of Kim-1 in the diagnosis of AKI was from 0.9 to 0.95. However, Kim-1 showed weak association with the need of renal replacement therapy and death of AKI patient. Kim-1 is a potential novel urinary biomarker in the early detection of AKI within 24 hours after kidney insult. It might be especially beneficial in the diagnosis of ischemic ATN.