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Assessing the Role of Chemokine (C–C Motif) Ligand 14 in AKI: a European Consensus Meeting

Jay L. Koyner,Christian Arndt, Jaume Baldira Martinez de Irujo,Silvia Coelho, Manuel Garcia-Montesinos de la Pena,Luca di Girolamo,Michael Joannidis,Pablo Jorge-Monjas, Christian Koch, Steven Lobaz, Alain Meyer,Marlies Ostermann, Nicoletta Pertica,John R. Prowle, Jon Silversides,Alexander Zarbock,Jorge Echeverri,Kai Harenski,Lui G. Forni

RENAL FAILURE(2024)

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Abstract
Background: Urinary Chemokine (C-C motif) ligand 14 (CCL14) is a biomarker associated with persistent severe acute kidney injury (AKI). There is limited data to support the implementation of this AKI biomarker to guide therapeutic actions. Methods: Sixteen AKI experts with clinical CCL14 experience participated in a Delphi-based method to reach consensus on when and how to potentially use CCL14. Consensus was defined as >= 80% agreement (participants answered with 'Yes', or three to four points on a five-point Likert Scale). Results: Key consensus areas for CCL14 test implementation were: identifying challenges and mitigations, developing a comprehensive protocol and pairing it with a treatment plan, and defining the target population. The majority agreed that CCL14 results can help to prioritize AKI management decisions. CCL14 levels above the high cutoff (> 13 ng/mL) significantly changed the level of concern for modifying the AKI treatment plan (p < 0.001). The highest level of concern to modify the treatment plan was for discussions on renal replacement therapy (RRT) initiation for CCL14 levels > 13 ng/mL. The level of concern for discussion on RRT initiation between High and Low, and between Medium and Low CCL14 levels, showed significant differences. Conclusion: Real world urinary CCL14 use appears to provide improved care options to patients at risk for persistent severe AKI. Experts believe there is a role for CCL14 in AKI management and it may potentially reduce AKI-disease burden. There is, however, an urgent need for evidence on treatment decisions and adjustments based on CCL14 results.
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Key words
Biomarker testing experience,C-C motif chemokine ligand 14 (CCL14),consensus,critical care nephrology,persistent acute kidney injury
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