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May 29, 2026Kidney Medicine0 citationsOpen Access

Impact of Using Biomarkers in Eligibility Criteria in Acute Kidney Injury Randomized Controlled Trials: A Systematic Review and Methodological Meta-Analysis

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FCF ChennouMSMichael StraderRARoxanne Authier

Key Points

  • This analysis aims to evaluate how using biomarkers in eligibility criteria impacts primary events in AKI trials and the associated statistical power.
  • Conducted a PRISMA-guided systematic review and methodological meta-analysis of RCTs from six databases.
  • Included trials with biomarker-based eligibility criteria published between 2010 and 2023.
  • Measured absolute risk difference between anticipated and observed event rates, stratifying by control and intervention groups.
  • Fourteen RCTs involving 3817 patients were analyzed.
  • Pooled absolute risk difference was 0.12 (95% CI; 0.06-0.17), with control and intervention groups showing 0.10 and 0.12 respectively.
  • Statistical power achieved was notably lower than planned, averaging 0.43 (±0.28).

Abstract

ABSTRACTRationale 0.06-0.17). In the control and interventional groups, the absolute risk differences were 0.10 (95%CI 0.01-0.19) and 0.12 (95%CI; 0.06-0.18) respectively. For kidney damage biomarkers, the risk difference was 0.13 (95% CI; 0.06-0.20). The mean pre-planned and achieved statistical powers were 0.84 (±0.07) and 0.43 (±0.28), respectively, with no improvement when extrapolating the pre-planned sample size. Limitations Most RCTs were underpowered for their primary outcome. There was a high level of heterogeneity. Conclusions There is a difference between expected and observed incidence rates that may be partly attributed to biomarker-based enrichment methods. These findings highlight the need for rigorous validation of biomarkers before their incorporation into the eligibility criteria of RCTs.

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Cite This Study

Chennou et al. (2026) studied this question.

synapsesocial.com/papers/6a192cb4fab5b468c441585dhttps://doi.org/10.1016/j.xkme.2026.101415
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