Pro: Prevention of acute kidney injury: time for teamwork and new biomarkers.

Acute kidney injury (AKI) is a common condition in critically ill patients. Multiple studies have identified AKI as a strong independent risk factor for higher morbidity and mortality. AKI is often multifactorial, asymptomatic and difficult to predict. In recent years, the discovery of several AKI biomarkers, including the recent validation and approval of cell cycle arrest biomarkers (NephroCheck, Astute Medical, San Diego, CA, USA), has provided additional tools to detect patients at high risk of AKI and improve their outcomes. We propose a protocol to integrate the use of NephroCheck into a multidisciplinary rapid clinical response team to potentially reduce AKI development, severity and the number of patients who need dialysis. We have designed a stepped alarm system for nephrologists and critical care physicians that starts with the recognition of high-risk patients in the clinical setting. The evaluation of patients' clinical situation together with the NephroCheck value will lead to a list of recommendations to prevent the development of AKI or progression to acute kidney stress or injury. We propose that the routine clinical application of a NephroCheck Rapid Response Team (RRT), where the NephroCheck RRT acts under the principle of improving safety and avoiding deterioration of patients, can impact patients' well-being in a positive way.