EXPRESS: Clinical adoption of Nephrocheck® in the early detection of acute kidney injury.

Acute kidney injury (AKI) is a common complication of acute illnesses and is associated with increased morbidity and mortality. Over the past years several AKI biomarkers for diagnostication, decision-making processes, and prognosistication of AKI and its outcomes have been developed and validated. Among these biomarkers, tissue inhibitor of metalloproteinase-2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP7), the so-called cell cycle arrest biomarkers, showed a superior profile of accuracy and stability even in patients with substantial comorbidities. Therefore, in 2014, the US Food and Drug Administration approved the use of the product of TIMP-2 and IGFBP7 ([TIMP-2]x[IGFBP7]), known as cell cycle arrest biomarkers, to aid critical care physicians and nephrologists in the early prediction of AKI in the critical care setting. To date, Nephrocheck® is the only commercially available test for [TIMP-2]x[IGFBP7].In this narrative review, we describe the growing clinical and investigational momentum of biomarkers, focusing on [TIMP-2]x[IGFBP7], as one of the most promising candidate biomarkers. Additionally, we review the current state of clinical implementation of Nephrocheck®.