Evidence mapPaperPMID 41880297Full record

ArticlePloS one2026

International Delphi consensus on acute kidney injury: Foundations for AI-driven digital twin development in critical care nephrology.

Mehdi Kashani, Jacob Ninan, Lifang Wei, Wisit Cheungpasitporn, Amos Lal, Ognjen Gajic, Kianoush Kashani

Abstract readConsensus Statement
In one paragraph

Article in PloS one, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Mehdi KashaniDivision of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, United States of America.ORCID https://orcid.org/0000-0001-6868-6481
Jacob NinanDivision of Critical Care and Nephrology, Department of Medicine, MultiCare Capital Medical Center, Olympia, Washington, United States of America.
Lifang WeiDivision of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, United States of America.
Wisit CheungpasitpornDivision of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, United States of America.
Amos LalDivision of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, United States of America.
Ognjen GajicDivision of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, United States of America.
Kianoush KashaniDivision of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, United States of America.ORCID https://orcid.org/0000-0003-2184-3683

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAcute kidney injury (AKI) in critically ill patients is clinically complex and heterogeneous, limiting the development of structured simulation models. Digital twin approaches require clearly defined causal relationships grounded in expert consensus. We aimed to establish an international Delphi consensus to inform the development of an interpretable, AI-driven digital twin framework for AKI in critical care.

methodsWe conducted a modified Delphi study involving up to three survey rounds. Experts in nephrology and critical care were invited to evaluate statements addressing AKI etiology, biomarker integration, biopsy indications, contrast use, and ICU management. Consensus was predefined as ≥75% agreement.

resultsFifty-six experts were invited, and 49 completed the first round. Consensus was achieved after two rounds. Hemodynamic instability and nephrotoxicity were identified as leading contributors to AKI. Experts supported integrating biomarkers beyond serum creatinine and urine output, although agreement varied for specific assays. Daily biomarker assessment reached consensus, whereas contrast use in advanced AKI stages did not. Desmopressin use prior to kidney biopsy in patients with markedly elevated blood urea nitrogen achieved consensus. A structured Directed Acyclic Graph was developed to represent the expert-derived causal framework.

conclusionsThis Delphi study established a clinically grounded framework for AKI in critical care while highlighting areas of practice variability. The resulting causal structure provides a transparent foundation for future AI-driven digital twin development and prospective validation.

Indexed as

Acute Kidney InjuryArtificial IntelligenceCritical CareNephrologyBiomarkersDelphi TechniqueHumansBiomarkers

Identifiers

PMID41880297
PMCPMC13016343

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.