The clinical utility of kidney injury molecule 1 in the prediction, diagnosis and prognosis of acute kidney injury: a systematic review.

OBJECTIVE: 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). METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.