# Acute op chronische nierziekte: harmonisatie van definities en cystatine-C-biomarkers verbeteren risicoprofiel

*geplaatst 2026-11-05 · Nierziekte · Renal failure · doi 10.1080/0886022X.2026.2746268 · https://hartvaat.nl/2026/12/01/acute-op-chronische-nierziekte-harmonisatie-van-definities-en-cystatine-c-biomar/*

Deze kritische review analyseert de huidige richtlijnen en literatuur over acute nierfunctiedaling bij patiënten met bestaande chronische nierziekte (AoCKD). Er heerst grote heterogeniteit in definities, wat de incidentie varieert van 1 tot 33%; cystatine-C-gebaseerde eGFR blijkt superieur aan creatinine voor het voorspellen van sterfte en progressie. Harmonisatie van diagnostische criteria en vroegtijdige inzet van biomarkers zijn essentieel om de hoge cardiovasculaire sterfte en nierdeterioratie bij deze kwetsbare groep beter te managen.

## English: Acute‑on‑chronic kidney disease (AoCKD): a critical appraisal and call for action to define boundaries and optimize management.

This critical review evaluates current guidelines and literature on acute kidney injury superimposed on chronic kidney disease (AoCKD), highlighting significant heterogeneity in diagnostic criteria and wide incidence ranges (1–33%). Cystatin C-based eGFR demonstrates superior prognostic accuracy for mortality and disease progression compared to creatinine alone. Standardized definitions and earlier incorporation of sensitive biomarkers are urgently needed to improve risk stratification and management in this high cardiovascular risk population.

## Abstract (original, from the publication)

Acute‑on‑chronic kidney disease (AoCKD) refers to an acute decline in renal function occurring in individuals with established CKD. Despite its major clinical impact-including increased mortality, accelerated CKD progression, and higher cardiovascular risk-AoCKD remains underrepresented within major guideline frameworks (KDIGO, ADQI, NICE). Our review aims to critically appraise existing guideline frameworks, definitions, biomarkers, imaging recommendations, and research gaps related to AoCKD, and to highlight priorities for future harmonization and clinical integration. We conducted a targeted literature search of PubMed, Embase, and the Cochrane Library, to identify guidelines, consensus reports, observational studies, and systematic reviews describing acute deterioration in CKD. Extracted data included definitional criteria, epidemiology, biomarker performance, imaging guidance, and prognostic outcomes. Current KDIGO, ADQI, and NICE frameworks were evaluated in parallel. We report marked heterogeneity in definitions describing acute deterioration in CKD, with terms including AoCKD, AKI‑on‑CKD, acute pre‑existing kidney dysfunction, and cROCK‑based definitions. Reported incidence varies widely (1-33%) due to inconsistent criteria. Creatinine‑based definitions show reduced prognostic accuracy in CKD populations, whereas cystatin‑C-based eGFR demonstrates superior discrimination for mortality and progression. We propose an operational definition of AoCKD that includes functional criteria and biomarker-based criteria. The definition reflects the increased mortality in this phenotype even before reaching the KDIGO-AKI threshold. In conclusion, AoCKD is a clinically significant but poorly defined state within the kidney disease continuum. Harmonized definitions, incorporation of cystatin‑C-based markers, structured imaging pathways, and integration of early biomarkers are urgently needed.

Auteurs: Amin R Soliman, Karim M Soliman, Salwa Ibrahim Mohamed, Mohamed Mostafa Elkhatib, Mohamed Momtaz, Mahmoud M Elnokeety, Ahmed Aly, Hoda Maamoun, Tarek S Abdelaziz, Hany Hammad, Mahmoud M Shaheen, Rasha Ahmed Darwish, Ahmed Fayed, Dina A Abdellatif, Nouran Hatem Samir, Ahmed S Hegazy, Sahier El-Khashab

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Bron: Renal failure, https://doi.org/10.1080/0886022X.2026.2746268. Bijgewerkt 2026-10-30T02:05:11Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.