Specialist commentator comments
Comments on this technology were invited from clinical specialists working in the field and relevant patient organisations. The comments received are individual opinions and do not represent NICE's view.
Six specialists 3 of whom were familiar with this technology contributed to this briefing. One of the experts had used the technology only in research.
All the specialists agreed that the technology was innovative. Two experts noted that the novelty was the development of a commercial product given that many putative markers of kidney injury have been investigated. Another expert noted that NephroCheck test is novel in its ability to predict the development of acute kidney injury (AKI) stage 2 and stage 3. Another expert felt that the prospect of using a preventive 'bundle' for patients with a positive NephroCheck test is novel. One expert noted that to show true clinical innovation, evidence needs to show that the use of NephroCheck test alters outcomes and allows changes in care pathways. One expert stated that potentially NephroCheck had some clinical application but requires analytical and clinical validation.
All experts agreed that early detection of AKI would allow early introduction of AKI care. One expert noted that early application of corrective measures may reduce the likelihood of requiring temporary dialysis. Another expert felt that if appropriate evidence is generated, NephroCheck test may potentially decrease morbidity, mortality, length of stay and risk of chronic kidney disease. This expert further stated NephroCheck may be useful in triaging patients. Two experts noted that early identification of patients at higher risk will help with close monitoring of these patients. One expert highlighted the need to give further consideration to identifying the cause of AKI. Another expert noted the importance of monitoring the clinicians' response to the test results and how this influences the start of treatment, as the technology could potentially change current practice.
Three experts noted that if there were evidence to prove that NephroCheck influences outcomes, its use could potentially result in significant resource savings, reduced length of hospital stay, reduced use of critical care beds and reduced requirement for dialysis. However, 1 expert felt that given the low specificity of the test, it may be potentially resource intensive. Another expert felt NephroCheck could potentially allow clinicians to make an earlier diagnosis on patients at risk of progressing to AKI stage 2 and 3. One expert noted that the benefit to the system would include a reduction in the need for renal replacement therapy and avoiding hyperkalaemia. Another expert noted that a negative test had potential to change a patient's management.