Kidney Week 2025 Annual Meeting-AKI Advances: Biomarkers, Outcomes, and Clinical Trials

Video Transcription

Video Summary

The session, moderated by nephrologists David Leaf and Jonathan Himmelfarb, featured rapid presentations on acute kidney injury (AKI) risk, mechanisms, prevention, and prognostication across multiple settings.<br /><br />In people with HIV who developed ambulatory AKI, Dr. Merv Postolju analyzed 211 cohort participants and found plasma tubular biomarkers at the AKI visit associated with 1‑year eGFR recovery: higher UMOD predicted better recovery, while higher KIM‑1 and TNFR1/2 predicted worse recovery; changes in TNFR2 from baseline to AKI also related to outcomes. Antiretroviral nephrotoxins (e.g., tenofovir) were adjusted for.<br /><br />A Dutch randomized trial (MERCURY‑2) tested perioperative dapagliflozin vs placebo in ~800 cardiac surgery patients. AKI incidence (KDIGO/urine-output heavy criteria) was significantly lower with dapagliflozin (28% vs 52%) without major safety signals, though follow-up was short and urine-output criteria drove most events.<br /><br />Dr. Elizabeth Kiernan examined dynamic sepsis-AKI subphenotypes (ANG2:ANG1 ratio and soluble TNFR1) in CLOVERS. About 13% transitioned phenotypes over 72 hours; moving to the “endothelial injury” phenotype (SP2) associated with worse mortality and dialysis-free days, while SP2→SP1 transitions improved outcomes. Restrictive fluids/early vasopressors increased SP2→SP1 transitions.<br /><br />A global WHO database study across 43 countries found AKI-related mortality overall stable from 1996–2021 with disparities by development and inequality; projections suggest modest increases to 2050 driven mainly by epidemiologic change.<br /><br />Other talks addressed: preoperative TNFR1 improving prediction/enrichment for cardiac surgery AKI trials; a Thai fast-track pathway for metformin-associated lactic acidosis reducing 30‑day mortality by accelerating dialysis; Digifab (anti-digoxin Fab) lowering CABG-AKI risk only in patients with high endogenous ouabain; synergistic nephrotoxic drug combinations affecting severe AKI risk; and urinary CXCL9 potentially identifying AIN patients more likely to benefit from corticosteroids.

Asset Subtitle

Moderator(s): Jonathan Himmelfarb, David Leaf

Presentation(s):

Plasma Biomarkers of Kidney Tubule Health and Kidney Function Recovery After Ambulatory AKI in People with HIV - Merve Postalcioglu
proMoting Effective Renoprotection in Cardiac sURgery patients by Inhibition of SGLT2 (MERCURI-2): A Randomized Controlled Trial in People Undergoing Cardiac Surgery - Maartina Oosterom-Eijmael
Temporal Kinetics of Sepsis-Associated AKI Subphenotypes - Elizabeth Kiernan
Temporal Trends in AKI-Related Mortality Across 43 Countries, 1996-2021, with Projections up to 2050: A Global Time Series Analysis and Modelling Study - Jeong-Yeun Lee
Preoperative Biomarkers for Enrichment of Clinical Trials in Cardiac Surgery-Associated AKI: A TRIBE Cohort Secondary Analysis - Lee Goeddel
Reducing Mortality in Metformin-Associated Lactic Acidosis Through a Fast-Track Clinical Pathway: A Controlled Interrupted Time Series Quality Improvement Study - Watanyu Parapiboon
Preoperative Immunoneutralization of Endogenous Ouabain Lowers the Risk for AKI Evoked by Cardiac Bypass Graft Surgery - Mordecai Blaustein
Effects of Nephrotoxic Medication Combinations on Rates of Stage 2/3 AKI - Casey Hardin
Urinary CXCL9 as a Predictive Biomarker of Corticosteroid Responsiveness in Acute Tubulointerstitial Nephritis - Sagar Sadarangani

Note: Continuing education credits are not being offered for this session.

Meta Tag

Date 11/8/2025

Pathway 1 AKI and Critical Care

Session ID 519808

Keywords

acute kidney injury

AKI biomarkers

HIV ambulatory AKI

UMOD

KIM-1

TNFR1 TNFR2

dapagliflozin

cardiac surgery AKI

MERCURY-2 trial

sepsis-associated AKI subphenotypes

ANG2 ANG1 ratio

WHO global AKI mortality

urinary CXCL9