Acute Kidney Injury and the Field of Dreams—If We Predict It, Maybe They’ll Come

An enormous challenge for developing new therapies to prevent acute kidney injury (AKI) is predicting who will develop it. In cardiac surgery, AKI is quite common, but the vast majority of cases are both mild and transient.¹ Severe cases, such as those meeting the Society of Thoracic Surgeons reportable AKI, defined as a 3-fold increase in serum creatinine value or initiation of dialysis, are relatively rare (<5%).¹ Not only are new drugs difficult to study, but quality improvement protocols designed to address this severity of AKI are very difficult to implement because most patients will not develop this level of injury.