1 Recommendations

1 Recommendations

1.1 There is not enough evidence to recommend the routine use of the ARCHITECT and Alinity i Urine neutrophil gelatinase-associated lipocalin (NGAL) assays, BioPorto NGAL test or NephroCheck test to help assess the risk of acute kidney injury for people being considered for critical care admission.

1.2 Further research is recommended to assess:

  • the clinical effectiveness of defined care bundles to prevent or reduce the effect of acute kidney injury in defined NHS patient populations who could benefit from preventive care for acute kidney injury (see section 5.1)

  • the effect on clinical outcomes of having the tests to guide care to prevent acute kidney injury (see section 5.2).

Why the committee made these recommendations

Using the tests may help to identify people with acute kidney injury earlier than monitoring serum creatinine and urine levels alone. But it is not clear how much this will benefit people being considered for admission to critical care in the NHS, for example, by reducing their hospital stay or likelihood of needing renal replacement therapy in hospital.

The cost-effectiveness estimates for the tests are very uncertain. But they are likely to be much higher than what NICE normally considers a cost-effective use of NHS resources. Therefore, these tests are not recommended for use in the NHS.

There is considerable uncertainty about which patients in the NHS could benefit from the tests. This is because preventive care for acute kidney injury may already be done (in full or in part) as standard practice, which limits the effect that the test results can have on guiding care. Further research may identify specific populations in the NHS who could benefit from the tests, and by how much.

  • National Institute for Health and Care Excellence (NICE)